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Lenti MV, Aronico N, Bianchi PI, D'Agate CC, Neri M, Volta U, Mumolo MG, Astegiano M, Calabrò AS, Zingone F, Latella G, Di Sario A, Carroccio A, Ciacci C, Luzza F, Bagnato C, Fantini MC, Elli L, Cammarota G, Gasbarrini A, Portincasa P, Latorre MA, Petrucci C, Quatraccioni C, Iannelli C, Vecchione N, Rossi CM, Broglio G, Ianiro G, Marsilio I, Bibbò S, Marinoni B, Tomaselli D, Abenavoli L, Pilia R, Santacroce G, Lynch E, Carrieri A, Mansueto P, Gabba M, Alunno G, Rossi C, Onnis F, Efthymakis K, Cesaro N, Vernero M, Baiano Svizzero F, Semeraro FP, Silano M, Vanoli A, Klersy C, Corazza GR, Di Sabatino A. Diagnostic delay in adult coeliac disease: An Italian multicentre study. Dig Liver Dis 2022; 55:743-750. [PMID: 36567177 DOI: 10.1016/j.dld.2022.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD). AIMS To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD. METHODS CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted. RESULTS Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay. CONCLUSION We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicola Aronico
- First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Ilaria Bianchi
- First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmela Cinzia D'Agate
- Department of Gastroenterology and Endoscopy, University Hospital "G. Rodolico", Catania, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Gloria Mumolo
- Department of General Surgery and Gastroenterology, Pisa University Hospital, Pisa, Italy
| | - Marco Astegiano
- SC Gastroenterologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonino Salvatore Calabrò
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio" University of Florence, Florence, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, and Gastroenterology Unit, Azienda Ospedale Università, Padova, Italy
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Di Sario
- Department of Gastroenterology and Transplantation, Polytechnic Marche University, Ancona, Italy
| | - Antonio Carroccio
- Internal Medicine Unit, "V. Cervello Hospital", University of Palermo, Palermo, Italy
| | - Carolina Ciacci
- Department of Medicine and Surgery, Gastroenterology Unit, University of Salerno, Salerno, Italy
| | - Francesco Luzza
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Carmela Bagnato
- Clinical Nutrition Unit, Madonna delle Grazie Hospital, Matera, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giovanni Cammarota
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Clinica Medica "A. Murri", Bari, Italy
| | - Mario Andrea Latorre
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Clarissa Petrucci
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Quatraccioni
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Iannelli
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Nicoletta Vecchione
- Department of Gastroenterology and Endoscopy, University Hospital "G. Rodolico", Catania, Italy
| | - Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Broglio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Ianiro
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Ilaria Marsilio
- Department of Surgery, Oncology and Gastroenterology, University of Padua, and Gastroenterology Unit, Azienda Ospedale Università, Padova, Italy
| | - Stefano Bibbò
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Beatrice Marinoni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Ludovico Abenavoli
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Riccardo Pilia
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giovanni Santacroce
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erica Lynch
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio" University of Florence, Florence, Italy
| | - Antonella Carrieri
- Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Clinica Medica "A. Murri", Bari, Italy
| | - Pasquale Mansueto
- Internal Medicine Unit, "V. Cervello Hospital", University of Palermo, Palermo, Italy
| | - Margherita Gabba
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Alunno
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Rossi
- Department of Gastroenterology and Transplantation, Polytechnic Marche University, Ancona, Italy
| | - Francesca Onnis
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Konstantinos Efthymakis
- Department of Medicine and Ageing Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Nicola Cesaro
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marta Vernero
- SC Gastroenterologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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