The diagnosis of Crohn's disease (CD) can be delayed in clinical practice. 

In tuberculosis endemic areas, empirical anti‐tubercular therapy further delays treatment.

Dr Banerjee and colleagues assessed risk factors for diagnostic delay and its impact on the long‐term complications of Crohn's disease in India where tuberculosis is endemic.

Data from a large prospectively established inflammatory bowel disease registry were analyzed retrospectively. 

The time from onset of symptoms to diagnosis was calculated and categorized into 2 groups based on median diagnostic delay. 

The risk factors for delay including anti‐tubercular therapy were analyzed.

 

Logistic regression analysis was done to assess impact of diagnostic delay on development of stenotic and fistular complications including need for surgery.

The team included 720 Crohn's disease patients. 

Main outcome measures were stenosis, fistula and need for surgery. 

Subjects with diagnostic delay >18 months developed significantly higher stenotic complications and surgery, respectively, compared to those ≤18 months.

The research team found no difference in the development of fistulous complications. 

The team found that 27% received anti‐tubercular therapy which significantly contributed to diagnostic delay with 47% showing initial clinical response.

Moreover, the incidence of stenotic complications was significantly higher in patients who had received prior anti‐tubercular therapy.

Dr Banerjee's team concludes, "Diagnostic delay in Crohn's disease is associated with significantly higher stenotic complications and need for surgery."

"Empirical anti‐tubercular therapy is the single largest contributor to diagnostic delay in tuberculosis endemic areas."

"Despite initial clinical response to anti‐tubercular therapy, long‐term stenotic complications are higher."