Cargando…
Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use
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 K...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397722/ https://www.ncbi.nlm.nih.gov/pubmed/30833804 http://dx.doi.org/10.3748/wjg.v25.i8.989 |
_version_ | 1783399449694830592 |
---|---|
author | Kang, Ho Suk Koo, Ja Seol Lee, Kang Moon Kim, Dae Bum Lee, Ji Min Kim, Yoon Jae Yoon, Hyuk Jang, Hyun Joo |
author_facet | Kang, Ho Suk Koo, Ja Seol Lee, Kang Moon Kim, Dae Bum Lee, Ji Min Kim, Yoon Jae Yoon, Hyuk Jang, Hyun Joo |
author_sort | Kang, Ho Suk |
collection | PubMed |
description | 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 follow-up] at each diagnostic interval. RESULTS: The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75(th) 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. |
format | Online Article Text |
id | pubmed-6397722 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-63977222019-03-04 Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use Kang, Ho Suk Koo, Ja Seol Lee, Kang Moon Kim, Dae Bum Lee, Ji Min Kim, Yoon Jae Yoon, Hyuk Jang, Hyun Joo World J Gastroenterol Retrospective Study 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 follow-up] at each diagnostic interval. RESULTS: The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75(th) 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. Baishideng Publishing Group Inc 2019-02-28 2019-02-28 /pmc/articles/PMC6397722/ /pubmed/30833804 http://dx.doi.org/10.3748/wjg.v25.i8.989 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Retrospective Study Kang, Ho Suk Koo, Ja Seol Lee, Kang Moon Kim, Dae Bum Lee, Ji Min Kim, Yoon Jae Yoon, Hyuk Jang, Hyun Joo Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
title | Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
title_full | Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
title_fullStr | Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
title_full_unstemmed | Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
title_short | Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
title_sort | two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use |
topic | Retrospective Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397722/ https://www.ncbi.nlm.nih.gov/pubmed/30833804 http://dx.doi.org/10.3748/wjg.v25.i8.989 |
work_keys_str_mv | AT kanghosuk twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT koojaseol twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT leekangmoon twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT kimdaebum twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT leejimin twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT kimyoonjae twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT yoonhyuk twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause AT janghyunjoo twoyeardelayinulcerativecolitisdiagnosisisassociatedwithantitumornecrosisfactoralphause |