TY - JOUR
T1 - Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use
AU - Kang, Ho Suk
AU - Lee, Kang Moon
AU - Kim, Dae Bum
AU - Lee, Ji Min
AU - Kim, Yoon Jae
AU - Yoon, Hyuk
AU - Jang, Hyun Joo
AU - Koo, Ja Seol
N1 - Publisher Copyright:
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - BACKGROUND Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients. AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients. METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval. RESULTS The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916). CONCLUSION A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.
AB - BACKGROUND Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients. AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients. METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval. RESULTS The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916). CONCLUSION A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.
KW - Anti-tumor necrosis factor alpha
KW - Diagnostic delay
KW - Smoking
KW - Ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=85062428617&partnerID=8YFLogxK
U2 - 10.3748/wjg.v25.i8.989
DO - 10.3748/wjg.v25.i8.989
M3 - Article
C2 - 30833804
AN - SCOPUS:85062428617
SN - 1007-9327
VL - 25
SP - 989
EP - 1001
JO - World journal of gastroenterology
JF - World journal of gastroenterology
IS - 8
ER -