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Cited 5 time in webofscience Cited 6 time in scopus
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Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha useopen access

Authors
Kang, Ho SukKoo, Ja SeolLee, Kang MoonKim, Dae BumLee, Ji MinKim, Yoon JaeYoon, HyukJang, Hyun Joo
Issue Date
28-Feb-2019
Publisher
BAISHIDENG PUBLISHING GROUP INC
Keywords
Ulcerative colitis; Diagnostic delay; Anti-tumor necrosis factor alpha; Smoking
Citation
WORLD JOURNAL OF GASTROENTEROLOGY, v.25, no.8, pp.989 - 1001
Indexed
SCIE
SCOPUS
Journal Title
WORLD JOURNAL OF GASTROENTEROLOGY
Volume
25
Number
8
Start Page
989
End Page
1001
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/2370
DOI
10.3748/wjg.v25.i8.989
ISSN
1007-9327
Abstract
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)-alpha 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; 75th percentile, 195 d). Among the prognostic factors, anti-TNF alpha 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%Cl: 3.5%-34.053). Anti-TNF alpha 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-TNF alpha use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.
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Koo, Ja Seol
Ansan Hospital (Department of Gastroenterology and Hepatology, Ansan Hospital)
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