Impact of Diagnostic Delay on Disease Course in Pediatric- versus Adult-Onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

Alain M Schoepfer; Vu Dang Chau Tran; Jean-Benoit Rossel; Christiane Sokollik; Johannes Spalinger; Ekaterina Safroneeva; Thea von Graffenried; Sébastien Godat; Dieter Hahnloser; Stephan R Vavricka; Christian Braegger; Andreas Nydegger

doi:10.1159/000520995

Impact of Diagnostic Delay on Disease Course in Pediatric- versus Adult-Onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

Inflamm Intest Dis. 2021 Nov 18;7(2):87-96. doi: 10.1159/000520995. eCollection 2022 Jul.

Affiliations

¹ Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
² Division of Pediatric Gastroenterology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
³ Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁴ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, University of Bern, Bern, Switzerland.
⁵ Division of Pediatric Gastroenterology, Children's Hospital LUKS, Lucerne, Switzerland.
⁶ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁷ Division of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
⁸ Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
⁹ Nutrition Research Unit, University Children's Hospital Zurich, Zurich, Switzerland.

Abstract

Introduction: Given the lack of data, we aimed to assess the impact of the length of diagnostic delay on the natural history of ulcerative colitis (UC) in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years).

Methods: Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed. Diagnostic delay was defined as the interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extraintestinal manifestations (EIMs).

Results: A total of 184 pediatric and 846 adult patients were included. The median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (p = 0.873). In both, pediatric- and adult-onset groups, the length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIMs were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay than in the adult-onset group with short diagnostic delay (p = 0.022). In the long term, the length of diagnostic delay was associated in the adult-onset group with colorectal dysplasia (p = 0.023), EIMs (p < 0.001), and more specifically arthritis/arthralgias (p < 0.001) and ankylosing spondylitis/sacroiliitis (p < 0.001). In the pediatric-onset UC group, the length of diagnostic delay in the long term was associated with arthritis/arthralgias (p = 0.017); however, it was not predictive for colectomy and UC-related hospitalization.

Conclusions: As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.

Keywords: Colectomy; Diagnostic delay; Inflammatory bowel disease; Natural history; Ulcerative colitis.