Diagnostic management of patients with inflammatory bowel disease

Background: The period of time required for the diagnosis of a chronic illn ess depends on initial clinical symptoms and their perception by the patien t and the physicians. The aim of this study was to describe the procedures of diagnosis of incident cases of Inflammatory Bowel Disease (IBD). Methods: Patients reported by the Registry of inflammatory bowel disease of northern France (EPIMAD) in 1994 were included. Standardized questionnaire s describing clinical history, patient behavior, medical consultations and examinations were collected by an interviewer practitioner from three sourc es: patients, general practitioners (GP) and gastroenterologists (GE). Pati ents were divided in 2 groups according to the time between symptom onset a nd diagnosis: more than 9 months or less than 9 months (D>9 and D less than or equal to 9). Results: 258 patients were included: 144 Crohn's disease (CD) (56%), 106 ul cerative colitis (UC) (41%) and 8 chronic unclassifiable colitis (CUC). Med ian time between symptom onset and diagnosis was 3 months, 196 (76%) patien ts belonged to the group D less than or equal to 9 and 62 (24%) to the grou p D>9. There was no difference between the 2 groups for initial clinical sy mptoms. The delay between symptom onset and the consultation to the GP and the GE was longer in the group D>9: respectively 1 month vs 0 and 7.6 vs 2. Thirty-five percent of patients in the group D>9 had consulted more than o ne GP vs 14% (p<0.05). Diagnosis management by the GE was the same in both groups. Patients of group D less than or equal to 9 had more often perceive d their symptoms as serious (p<0.05). Conclusions: Delay to diagnosis in a quarter of patients with IBD was more than 9 months. This later diagnosis was not due to patient management by th e GE but rather to a longer delay to consulting the GP and between GP and G E referral. Patient interpretation of the symptoms could also explain the v ariability of this delay.