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Presenting symptoms and diagnostic lag in children with inflammatory bowel disease
J B Heikenen1, S L Werlin, C W Brown
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226, USA.
Insights
Diagnosing pediatric inflammatory bowel disease (IBD) involves a significant time lag, especially for Crohn's disease (CD) and ulcerative colitis (UC). Symptoms like abdominal pain and diarrhea contribute to delays, with growth failure indicating the longest diagnostic delays.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Timeliness Studies
Background:
- Presenting symptoms and their duration can influence the time to definitive diagnosis of inflammatory bowel disease (IBD).
- Understanding diagnostic lag is crucial for timely intervention in pediatric IBD cases.
Purpose of the Study:
- To determine the mean duration of presenting symptoms and diagnostic lag in children diagnosed with IBD.
- To analyze factors influencing diagnostic delay in pediatric Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis.
Main Methods:
- Retrospective review of medical records for pediatric patients (<19 years) diagnosed with IBD between 1990-1995.
- Analysis of age at diagnosis, gender, symptoms, disease location, and diagnostic lag.
- Categorization of IBD types including CD, UC, and indeterminate colitis.
Main Results:
- 91 children diagnosed with IBD; CD (58), UC (24), indeterminate (9).
- Average diagnostic lag: CD 7.1 months (small intestine 10.5, ileocolonic 7.5, colonic 6.4), UC 6.7 months, indeterminate 14 months.
- Children with growth failure experienced the longest diagnostic lag; diagnostic lag for CD has decreased over time.
Conclusions:
- Diagnostic lag in pediatric IBD varies by disease type and location.
- Growth failure is a significant indicator of prolonged diagnostic delay in pediatric IBD.
- While diagnostic time for CD has improved, UC diagnosis remains only slightly faster.
Abstract:
Presenting symptoms and their duration may affect the time that elapses prior to definitive diagnosis of inflammatory bowel disease (IBD). This study was undertaken to determine the mean duration of presenting symptoms and diagnostic lag in children with IBD. The medical records of all patients less than 19 years of age diagnosed with IBD at the pediatric gastroenterology clinic of Children's Hospital of Wisconsin between 1990-1995 were reviewed. The age at diagnosis, gender, presenting symptoms and duration, disease location, and diagnostic lag were analyzed. There were 91 children (49 male) diagnosed with IBD. Crohn's disease (CD) was diagnosed in 58, ulcerative colitis (UC) in 24, and indeterminate colitis in 9. The mean ages at diagnosis were 11.4 years for CD, 9.7 years for UC, and 7.8 years for indeterminate colitis. The most frequent presenting symptoms were abdominal pain, diarrhea, hematochezia, and weight loss. The average lag in diagnosis of CD was 7.1 months, which varied by disease location: small intestine 10.5 months, ileocolonic 7.5 months, and colonic 6.4 months. The average lag in diagnosis was 6.7 months for UC and 14 months for indeterminate colitis. Children presenting with growth failure had the longest diagnostic lag. (a) The elapsed time between symptom onset and the diagnosis of CD has decreased. (b) The diagnostic lag in CD decreases with distal colonic involvement. (c) Following onset of symptoms UC was diagnosed only slightly more rapidly than CD.