P346 Influence of diagnostic delay on ulcerative colitis characteristics at disease onset
Ramírez, C.(1);Barreiro-de Acosta, M.(2);Cabriada, J.L.(1);Rodríguez-Lago, I.(1)*;
(1)Hospital Universitario de Galdakao, Gastroenterology, Galdakao, Spain;(2)Hospital Clínico Universitario de Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain;
Background
Diagnostic delay (DD) is defined as the time between the onset of the first symptoms and the definitive diagnosis of IBD. It is highly heterogeneous and it has a negative impact on the disease course. Our objective was to describe the main clinical and histological characteristics at diagnosis of UC according to the DD and its influence on clinical course.
Methods
A retrospective study compiled information from consecutive patients diagnosed with UC between January 2015 and December 2019 and included in the ENEIDA registry in our hospital. Patient and disease characteristics at diagnosis such as age, DD, disease extent, partial Mayo Score (PMS), extraintestinal manifestations (EIM), fecal calprotectin (FC), and histological characteristics at diagnosis were compiled. The role of DD was evaluated as both quantitative and dichotomous variable using Spearman correlation, chi-square and Mann-Whitney tests.
Results
A total of 146 patients (53% male; 47% former smokers; median age 46 years [IQR, 34-56]; 27% E2 and 35% E3; median FC of 289 mg/kg (IQR, 105-586) with a median DD of 2 months (IQR, 1 -4) were included. The median PMS at diagnosis was 2 points (IQR, 2-5), with higher scores in patients with shorter DD (≤2 months, median 3 points [IQR, 2-5] vs >2 months, median 2 points [IQR, 2-4]; p=0.002). Among them, 7% of patients presented at least one EIM, reported more frequently in patients with a DD >2 months (1.4% with DD≤2 vs 13.4% with DD>2 months; p=0.007; Figure A). During follow-up, 9% developed proximal disease extension.
The most frequent histological findings were cryptic abscesses (71%), with a predominantly chronic infiltrate with basal plasmacytosis (97%), epithelial irregularity (83%), decreased mucosecretion (46%), erosions (21%), and ulceration (12%). The presence of eosinophils was more frequent as DD increases (5.6% if DD≤2 vs 18% if DD>2 months; p=0.029; Figure B), whereas the degree of chronic infiltration is more severe in patients with shorter DD (94% if DD≤2 vs 82% if DD>2 months; p=0.029; Figure C).
Conclusion
DD in UC influences the severity of clinical disease activity and the rate of EIM at diagnosis. In addition, eosinophils are more frequent as DD increases, while the degree of chronic infiltrate was more pronounced in patients with shorter disease duration.