Clinical and organizational features of ulcerative colitis and Crohn's disease differential diagnosis: the experience of the specialized City clinic for Inflammatory Bowel Diseases

Introduction. The initial diagnosis of ulcerative colitis and Crohn's disease – inflammatory bowel diseases (IBD) – is quite difficult, requiring a comprehensive evaluation of clinical and anamnesis data, the results of ilecolonoscopy with multifocal biopsy and, results of imaging diagnostic methods (in some cases).

The aim of the study: to estimate the duration of the time period required to establish the IBD diagnosis of and to assess the potential consequences of untimely establishment of this diagnosis.

Materials and methods. The data of 253 patients with ulcerative colitis and 263 patients with Crohn's disease who applied to the city center of St. Petersburg.

Results. In 59 % of ulcerative colitis patients with and in 65 % Crohn's disease patients the diagnosis was established within 3 months from first clinical sighs appearance. Evaluation of the possible association between the duration of the period required to establish the diagnosis of IBD and features of the course of IBD after diagnosis did not reveal a statistically significant association with the rate of recurrence and the risk of developing non-life-threatening complications. When studying the development of life-threatening complications of IBD it was found that only 59 % of such complications occurred after the diagnosis of IBD, while in the remaining cases they occurred either before or caused the diagnosis. Untimely diagnosis of IBD increased the risk of life-threatening complications by 18 times in patients with ulcerative colitis, and by 13 times in patients with Crohn's disease, compared to the situation when the diagnosis was established timely and specific IBD therapy for was initiated.

Conclusion. The majority of IBD patients, who suffered a life-threatening complication before the diagnosis was established, potentially had a temporary «window of opportunity», when on the basis of clinical data it was possible to suspect the presence of IBD, establish the diagnosis with the subsequent timely initiation of specific therapy to prevent a complicated course of the disease.

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