Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use  

作　　者：Ho Suk Kang Ja-Seol Koo Kang Moon Lee Dae-Bum Kim Ji Min Lee Yoon Jae Kim Hyuk Yoon Hyun Joo Jang 

机构地区：[1]Department of Internal Medicine,Hallym Sacred Heart Hospital,Hallym University College of Medicine,Anyang 14068,South Korea [2]Division of Gastroenterology and Hepatology,Department of Internal Medicine,Korea University Ansan Hospital,Department of Internal Medicine,Korea University College of Medicine,Ansan 15355,South Korea [3]Department of Internal Medicine,The Catholic University of Korea,St.Vincent’s Hospital,Suwon 16247,South Korea [4]Department of Gastroenterology,Gachon Graduate School of Medicine Gil Medical Center,Incheon 21565,South Korea [5]Department of Internal Medicine,Seoul National University Bundang Hospital,Seongnam 13620,South Korea [6]Division of Gastroenterology,Department of Internal Medicine,Dongtan Sacred Heart Hospital,Hallym University College of Medicine,Hwaseong 18450,South Korea

出　　处：《World Journal of Gastroenterology》2019年第8期989-1001,共13页世界胃肠病学杂志（英文版）

摘　　要：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)-αuse,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-TNFαuse 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-TNFαuse 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-TNFαuse.Age<60 years at diagnosis,smoking history,and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.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; 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.

关 键 词：ULCERATIVE colitis Diagnostic DELAY ANTI-TUMOR NECROSIS factor ALPHA SMOKING 

分 类 号：R[医药卫生]