IBD Diagnosis Delay and Its Predictors in Jordan: A Retrospective Study

Assem Al Refaei; Nour Shewaikani; Nader Alaridah; Mamoon M. D. Al-Rshaidat; Abdullah Alshurafa; Omar I. Hejazi; Osama Afaneh; Sereen Hamideh; Yaser M. Rayyan

doi:10.58877/japaj.v2i2.132

Authors

Assem Al Refaei School of Medicine, University of Jordan https://orcid.org/0000-0002-4592-4448
Nour Shewaikani https://orcid.org/0000-0002-5720-8924
Nader Alaridah Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan https://orcid.org/0000-0002-5744-7319
Mamoon M. D. Al-Rshaidat Department of Biological, Sciences, School of Sciences, The University of Jordan, Amman 11942, Jordan https://orcid.org/0000-0003-3047-5608
Abdullah Alshurafa School of Medicine, The University of Jordan, Amman 11942, Jordan. https://orcid.org/0000-0001-7002-5631
Omar I. Hejazi School of Medicine, The University of Jordan, Amman 11942, Jordan. https://orcid.org/0000-0002-3360-9993
Osama Afaneh School of Medicine, The University of Jordan, Amman 11942, Jordan.
Sereen Hamideh School of Medicine, Hashemite University, Zarqa 13110, Jordan.
Yaser M. Rayyan Department of Gastroenterology & Hepatology, School of Medicine, The University of Jordan, Amman 11942, Jordan https://orcid.org/0000-0002-0421-5143

DOI:

https://doi.org/10.58877/japaj.v2i2.132

Abstract

Aim: Delayed diagnosis of inflammatory bowel disease (IBD) may lead to increased treatment costs and surgical risks. This study aims to describe the extent of IBD diagnosis delay in Jordan.

Methods: Our study included 110 IBD patients, utilizing interviews and medical records from Jordan University Hospital. Data covered sociodemographic characteristics, health history, time from symptom onset to diagnosis, time from the first consultation to diagnosis, number of physicians consulted before diagnosis, and IBD-related surgical history.

Results: The median time from symptom onset to IBD diagnosis was 9 months. Median diagnosis times for Crohn's disease (CD) and ulcerative colitis (UC) were 11 and 9 months, respectively. Regression analysis revealed that longer diagnosis delays were associated with higher paternal education levels. Lower maternal education levels (high school or less) and a household income between 1200 and 2000 Jordanian dinars correlated with consulting more physicians before diagnosis.

Conclusions: Early aggressive treatment is essential for IBD, as delayed diagnosis negatively impacts patient outcomes. Further research is needed to identify factors contributing to diagnosis delay. Our findings suggest that parental education and income levels influence diagnosis delays, highlighting the importance of targeted awareness campaigns for specific population groups and general practitioners to mitigate delays.

Author Biography

Mamoon M. D. Al-Rshaidat, Department of Biological, Sciences, School of Sciences, The University of Jordan, Amman 11942, Jordan

Department of Biological, Sciences, School of Sciences, The University of Jordan, Amman 11942, Jordan

Laboratory for Molecular & Microbial Ecology (LaMME), School of Sciences, The University of Jordan, Amman 11942, Jordan

References

Tavakoli P, Vollmer-Conna U, Hadzi-Pavlovic D, Grimm MC. A Review of Inflammatory Bowel Disease: A Model of Microbial, Immune and Neuropsychological Integration. Public health reviews. 2021;42. DOI: https://doi.org/10.3389/phrs.2021.1603990

Perler B, Ungaro R, Baird G, Mallette M, Bright R, Shah S, et al. Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community-based inception cohort. BMC Gastroenterology. 2019;19(1). DOI: https://doi.org/10.1186/s12876-019-0963-7

Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User's Guide for Adult and Pediatric Gastroenterologists. Gastroenterology. 2021;161(1):47-65. DOI: https://doi.org/10.1053/j.gastro.2021.04.063

Announcement: World IBD Day - May 19, 2017. MMWR Morbidity and mortality weekly report2017. p. 516-. DOI: https://doi.org/10.15585/mmwr.mm6619a9

Zaharie R, Tantau A, Zaharie F, Tantau M, Gheorghe L, Gheorghe C, et al. Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery. Journal of Crohn's & colitis. 2016;10(3):306-14. DOI: https://doi.org/10.1093/ecco-jcc/jjv215

Loosen SH, Kostev K, Jördens MS, Luedde T, Roderburg C. Overlap between irritable bowel syndrome and common gastrointestinal diagnoses: a retrospective cohort study of 29,553 outpatients in Germany. BMC gastroenterology. 2022;22(1). DOI: https://doi.org/10.1186/s12876-022-02118-y

Lee D-W, Koo JS, Choe JW, Suh SJ, Kim SY, Hyun JJ, et al. Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery. World journal of gastroenterology. 2017;23(35):6474-81. DOI: https://doi.org/10.3748/wjg.v23.i35.6474

Nguyen VQ, Jiang D, Hoffman SN, Guntaka S, Mays JL, Wang A, et al. Impact of Diagnostic Delay and Associated Factors on Clinical Outcomes in a U.S. Inflammatory Bowel Disease Cohort. Inflammatory bowel diseases. 2017;23(10):1825-31. DOI: https://doi.org/10.1097/MIB.0000000000001257

Jayasooriya N, Baillie S, Blackwell J, Bottle A, Petersen I, Creese H, et al. Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Alimentary pharmacology & therapeutics. 2023. DOI: https://doi.org/10.1111/apt.17370

Team RC. R: A language and environment for statistical computing (Version 4.2.2) [Computer software]. R Foundation for Statistical Computing. https://www.R-project.org/; 2021.

Team RS. RStudio: Integrated Development Environment for R. 2021.

Wickham H, Averick M, Bryan J, Chang W, McGowan L, François R, et al. Welcome to the Tidyverse. Journal of Open Source Software. 2019;4(43):1686-. DOI: https://doi.org/10.21105/joss.01686

Kassambara A. ggpubr: 'ggplot2' Based Publication Ready Plots. 2023.

Wickham H. ggplot2: Elegant Graphics for Data Analysis. New York: Springer-Verlag; 2016. DOI: https://doi.org/10.1007/978-3-319-24277-4_9

Kassambara A. rstatix: Pipe-Friendly Framework for Basic Statistical Tests. 2023.

Stanley D. apaTables: Create American Psychological Association (APA) Style Tables. 2021.

Berg DR, Colombel JF, Ungaro R. The Role of Early Biologic Therapy in Inflammatory Bowel Disease. Inflammatory Bowel Diseases. 2019;25(12):1896-. DOI: https://doi.org/10.1093/ibd/izz059

Halabi H, Alarfaj A, Alawneh K, Alballa S, Alsaeid K, Badsha H, et al. Challenges and opportunities in the early diagnosis and optimal management of rheumatoid arthritis in Africa and the Middle East. International journal of rheumatic diseases. 2015;18(3):268-75. DOI: https://doi.org/10.1111/1756-185X.12320

Schreiber S, Reinisch W, Colombel JF, Sandborn WJ, Hommes DW, Robinson AM, et al. Subgroup analysis of the placebo-controlled CHARM trial: increased remission rates through 3 years for adalimumab-treated patients with early Crohn's disease. Journal of Crohn's & colitis. 2013;7(3):213-21. DOI: https://doi.org/10.1016/j.crohns.2012.05.015

Hamdeh S, Aziz M, Altayar O, Olyaee M, Murad MH, Hanauer SB. Early vs Late Use of Anti-TNFa Therapy in Adult Patients With Crohn Disease: A Systematic Review and Meta-Analysis. Inflammatory bowel diseases. 2020;26(12):1808-18. DOI: https://doi.org/10.1093/ibd/izaa031

Novacek G, Gröchenig HP, Haas T, Wenzl H, Steiner P, Koch R, et al. Diagnostic delay in patients with inflammatory bowel disease in Austria. Wiener klinische Wochenschrift. 2019;131(5-6):104-12. DOI: https://doi.org/10.1007/s00508-019-1451-3

Adedokun ST, Yaya S. Factors influencing mothers’ health care seeking behaviour for their children: evidence from 31 countries in sub-Saharan Africa. BMC Health Services Research. 2020;20(1):842-. DOI: https://doi.org/10.1186/s12913-020-05683-8

DeVoe JE, Tillotson CJ, Wallace LS, Angier H, Carlson MJ, Gold R. Parent and Child Usual Source of Care and Children’s Receipt of Health Care Services. Annals of Family Medicine. 2011;9(6):504-. DOI: https://doi.org/10.1370/afm.1300

Doocy S, Lyles E, Akhu-Zaheya L, Burton A, Burnham G. Health service access and utilization among Syrian refugees in Jordan. International journal for equity in health. 2016;15(1). DOI: https://doi.org/10.1186/s12939-016-0399-4

Shaheen AM, Hamdan KM, Alkaid Albqoor M, Arabiat DH. Perceived barriers to healthcare utilization among Jordanian families: A family centered approach. Applied nursing research : ANR. 2020;54. DOI: https://doi.org/10.1016/j.apnr.2020.151313

AbuAlRub RF. Nursing shortage in Jordan: what is the solution? Journal of professional nursing : official journal of the American Association of Colleges of Nursing. 2007;23(2):117-20. DOI: https://doi.org/10.1016/j.profnurs.2006.07.008