Background

Gastrointestinal (GI) symptoms of Inflammatory Bowel Disease (IBD) may go undiagnosed resulting in diagnostic delay.Aims: To determine the frequency and duration of GI symptoms in the decade before the diagnosis of Crohn’s Disease (CD) and ulcerative colitis (UC) and risk factors for delayed specialist review.

Methods

We used the Clinical Practice Research Datalink, a nationally representative research database, to identify incident cases of CD and UC diagnosed from 1998 to 2016. Comparison cohorts without IBD were matched 4:1 for age and sex and assigned the IBD diagnosis date of their matched IBD patient as a pseudo-diagnosis date. We compared the prevalence of GI symptoms between the IBD and comparison cohorts in the 10 years before IBD diagnosis. We identified individuals with chronic GI symptoms lasting more than 6 weeks and measured their time to receiving a specialist review with a gastroenterologist, paediatric gastroenterologist or colorectal surgeon. We identified risk factors for receiving specialist review after presenting with chronic GI symptoms.

Results

We identified 5874 incident cases of CD, 13,681 incident cases of UC and comparison cohorts of 78,114 individuals. 10% of the CD and UC cohorts reported GI symptoms to their primary care physician 5 years before diagnosis.Fewer than 50% of patients were reviewed by a specialist within 18 months of presenting to their primary care physician with chronic GI symptoms. Patients with a previous diagnosis of Irritable Bowel Syndrome (IBS) or depression were less likely to receive timely specialist review (IBS: HR 0.77, 95%CI 0.60–0.99, depression: HR 0.77, 95%CI 0.60–0.98).

Conclusion

A substantial number of individuals experience GI symptoms many years before receiving a diagnosis of IBD. IBS and depression are risk factors for delayed specialist review. Rapid diagnostic pathways should be established to reduce the burden of diagnostic delay in IBD.

中文翻译：

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P769炎症性肠病诊断前10年中胃肠道症状的发生率和持续时间：一项全国队列研究

背景

炎症性肠病（IBD）的胃肠道（GI）症状可能无法诊断，从而导致诊断延迟。目的：确定在诊断克罗恩病（CD）和溃疡性结肠炎（UC）和延迟专家审查的危险因素。

方法

我们使用了具有全国代表性的研究数据库临床实践研究数据链来鉴定1998年至2016年诊断为CD和UC的突发病例。没有IBD的比较人群的年龄和性别均按4：1进行匹配，并为其匹配的IBD诊断日期指定了IBD患者为假诊断日期。我们比较了IBD诊断之前10年中IBD和比较人群之间的GI症状患病率。我们确定了持续超过6周的慢性胃肠道症状的个体，并测量了他们接受胃肠病学家，小儿胃肠病学家或结直肠外科医生进行专业检查的时间。我们确定了出现慢性胃肠道症状后需要接受专家审查的风险因素。

结果

我们确定了5874例CD突发事件，13,681例UC突发事件和78,114个人的比较队列。10％的CD和UC队列在诊断前5年就向其初级保健医生报告了GI症状。不到50％的患者在向其初级保健医生提出慢性GI症状后的18个月内接受了专家的检查。先前诊断为肠易激综合症（IBS）或抑郁症的患者接受及时专科医生复查的可能性较小（IBS：HR 0.77，95％CI 0.60-0.99，抑郁症：HR 0.77，95％CI 0.60-0.98）。

结论

许多人在接受IBD诊断之前已经经历了GI症状。IBS和抑郁是延迟专家复查的危险因素。应建立快速诊断途径以减轻IBD诊断延迟的负担。