Jayasooriya, N; Baillie, S; Blackwell, J; Bottle, A; Petersen, I; Creese, H; Saxena, S; Pollok, RC; POP-IBD study group
(2023)
Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease.
Aliment Pharmacol Ther, 57 (6).
pp. 635-652.
ISSN 1365-2036
https://doi.org/10.1111/apt.17370
SGUL Authors: Pollok, Richard Charles G
|
PDF
Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (1MB) | Preview |
|
![]() |
Microsoft Word (.docx) (Tables S1-S16)
Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (288kB) |
Abstract
BACKGROUND: The impact of diagnostic delay on the clinical course of inflammatory bowel disease (IBD) remains uncertain. AIM: To perform a systematic review of time to diagnosis and the impact of delayed diagnosis on clinical outcomes in Crohn's disease (CD) and ulcerative colitis (UC). METHODS: We searched EMBASE and Medline from inception to 30th November 2022 for studies reporting diagnostic interval, from symptom onset to IBD diagnosis. We calculated the median, interquartile range (IQR) and pooled weighted median, of median diagnostic intervals of eligible studies. We defined delayed diagnosis as individuals above the 75th centile of longest time to diagnosis in each study. Using random effects meta-analysis, we pooled odds ratios (ORs) with 95% confidence intervals (CI) for studies reporting clinical outcomes, according to delayed diagnosis. RESULTS: One hunderd and one studies representing 112,194 patients with IBD (CD = 59,359; UC = 52,835) met inclusion criteria. The median of median times to diagnosis was 8.0 (IQR: 5.0-15.2) and 3.7 months (IQR: 2.0-6.7) in CD and UC, respectively. In high-income countries, this was 6.2 (IQR: 5.0-12.3) and 3.2 months (IQR: 2.2-5.3), compared with 11.7 (IQR: 8.3-18.0) and 7.8 months (IQR: 5.2-21.8) in low-middle-income, countries, for CD and UC respectively. The pooled weighted median was 7.0 (95% CI: 3.0-26.4) and 4.6 (95% CI: 1.0-96.0) months, for CD and UC respectively. Eleven studies, representing 6164 patients (CD = 4858; UC = 1306), were included in the meta-analysis that examined the impact of diagnostic delay on clinical outcomes. In CD, delayed diagnosis was associated with higher odds of stricturing (OR = 1.88; CI: 1.35-2.62), penetrating disease (OR = 1.64; CI: 1.21-2.20) and intestinal surgery (OR = 2.24; CI: 1.57-3.19). In UC, delayed diagnosis was associated with higher odds of colectomy (OR = 4.13; CI: 1.04-16.40). CONCLUSION: Delayed diagnosis is associated with disease progression in CD, and intestinal surgery in both CD and UC. Strategies are needed to achieve earlier diagnosis of IBD.
Item Type: | Article | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Additional Information: | © 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. | ||||||||||||
Keywords: | Crohn’s disease, clinical outcomes, delayed diagnosis, inflammatory bowel disease, phenotype, surgery, time to diagnosis, ulcerative colitis, POP-IBD study group, 1103 Clinical Sciences, 1115 Pharmacology and Pharmaceutical Sciences, Gastroenterology & Hepatology | ||||||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) | ||||||||||||
Journal or Publication Title: | Aliment Pharmacol Ther | ||||||||||||
ISSN: | 1365-2036 | ||||||||||||
Language: | eng | ||||||||||||
Dates: |
|
||||||||||||
Publisher License: | Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0 | ||||||||||||
Projects: |
|
||||||||||||
PubMed ID: | 36627691 | ||||||||||||
Go to PubMed abstract | |||||||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/115143 | ||||||||||||
Publisher's version: | https://doi.org/10.1111/apt.17370 |
Statistics
Actions (login required)
![]() |
Edit Item |