Supplementary Material for: Impact of Diagnostic Delay on Disease Course in Pediatric Versus Adult-onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

Introduction: Given the lack of data we aimed to assess the impact of the length of diagnostic delay on natural history of ulcerative colitis in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years). Methods: Data from the Swiss Inflammatory Bowel Disease cohort study were analyzed. Diagnostic delay was defined as interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extra-intestinal manifestations (EIM). Results: A total of 184 pediatric and 846 adult patients were included. Median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (P=0.873). In both, pediatric and adult-onset groups, length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIM were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay compared to the adult-onset group with short diagnostic delay (p = 0.022). In the long term, length of diagnostic delay was associated in the adult onset group with colorectal dysplasia (p=0.023), EIMs (p<0.001) and more specifically arthritis/arthralgias (p<0.001) and ankylosing spondylitis/sacroiliitis (p<0.001). In the pediatric-onset UC group, length of diagnostic delay in the long term was associated with arthritis/arthralgias (p=0.017); however, it was not predictive for colectomy and UC-related hospitalization. Conclusions: As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.

引言：鉴于目前相关数据的匮乏，本研究旨在探讨诊断延误时长对溃疡性结肠炎（UC）患者自然病程的影响，研究对象分为儿科发病组（确诊年龄<18岁）与成人发病组（确诊年龄≥18岁）。
方法：本研究分析了瑞士炎症性肠病队列研究的相关数据。诊断延误时长定义为溃疡性结肠炎相关症状首次出现至确诊的时间间隔。本研究采用逻辑回归模型，基于诊断延误时长，分析长期随访中以下并发症的发生情况：结肠上皮内瘤变、结直肠癌、UC相关住院治疗、结肠切除术以及肠外表现（EIM）。
结果：本研究共纳入184名儿科发病患者与846名成人发病患者。儿科发病组的诊断延误时长中位数为4个月[四分位数间距（IQR）2~7.5个月]，成人发病组为3个月[IQR 2~10个月]（P=0.873）。在两组患者中，UC确诊时的诊断延误时长均与结肠切除术、UC相关住院、结肠上皮内瘤变及结直肠癌无显著关联。与成人发病组中诊断延误时长较短的患者相比，诊断延误时长较长的成人发病组患者在确诊UC时的肠外表现患病率显著更高（P=0.022）。长期随访中，成人发病组的诊断延误时长与结直肠上皮内瘤变（P=0.023）、肠外表现（P<0.001）相关，具体表现为关节炎/关节痛（P<0.001）以及强直性脊柱炎/骶髂关节炎（P<0.001）的发生率升高。在儿科发病UC患者中，长期随访的诊断延误时长仅与关节炎/关节痛相关（P=0.017），而无法预测结肠切除术需求及UC相关住院情况。
结论：鉴于结直肠癌与肠外表现会导致显著的发病负担与医疗成本，应尽一切努力缩短UC患者的诊断延误时长。