Diagnostic Delay in Crohn’s Disease: Reality Today and Strategies to Overcome It

Abstract

Ulcerative colitis and Crohn`s disease are chronic inflammatory bowel diseases characterized by a chronic course, relapsing nature, and significant cumulative, irreversible bowel damage if adequate treatment is not introduced early. Over the last decades, we have witnessed an increase in the prevalence of inflammatory bowel diseases. The diagnostic delay is the period from the onset of the first inflammatory bowel disease-related symptoms to the moment of diagnosis. The prognosis of inflammatory bowel disease patients largely depends on a timely diagnosis and early treatment. Diagnostic delay is more frequent in Crohn`s disease than in ulcerative colitis due to the presence of more unspecific symptoms and the lack of blood in the stools of some Crohn`s disease patients. Early Crohn`s disease is defined as a disease diagnosed within 18 months from symptom onset, without complications and previous treatment. In these patients, therapeutic goals, presently set on transmural healing, are easier to achieve than in those diagnosed with significant diagnostic delay that, according to the available data in the literature, varies from 2 months to several years. Diagnostic delay in Crohn`s disease patients depends on many risk factors that are not well-defined in the available literature. Early diagnosis, followed by early therapeutic intervention, has been proven to significantly reduce the risk of complications and the need for surgical treatment. Patient risk stratification and subsequent therapy choice during the early stages of Crohn`s disease improve patient long-term outcomes and allow the change of the natural course of the disease. Therefore, overcoming diagnostic delay in Crohn`s disease patients is one of the crucial tasks for the future. A possible solution for diagnostic delay in Crohn`s disease patients is the development and implementation of efficient screening tools like the Red Flags Index and education of general practitioners to suspect possible Crohn`s disease and refer patients to gastroenterologists. There is a strong need for proper use of available biomarkers like fecal Ucalprotectin and the development of new, more specific ones. Only when this problem is overcome will more Crohn`s disease patients receive proper therapy on time which will ultimately improve their long-term outcomes and quality of life.