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Current diagnosis, management and morbidity in paediatric inflammatory bowel disease
C Spray1, G D Debelle, M S Murphy
1Institute of Child Health, University of Birmingham, Department of Paediatric Gastroenterology and Nutrition, UK.
Insights
Delayed diagnosis and inappropriate management remain significant issues for children with Crohn's disease and ulcerative colitis, impacting their health and growth.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Diagnosis
Background:
- Historically, delayed diagnosis in pediatric Crohn's disease was noted.
- Recent years have seen increased public awareness and suspected rise in incidence.
Purpose of the Study:
- To assess if heightened awareness improved diagnosis intervals for pediatric inflammatory bowel disease (IBD).
- To evaluate changes in clinical management and morbidity.
- To compare diagnostic delays between Crohn's disease and ulcerative colitis.
Main Methods:
- Retrospective study of 112 children with IBD (Crohn's disease, ulcerative colitis, indeterminate colitis).
- Data collected from a UK pediatric gastroenterology department between 1994-1998.
- Analysis of diagnostic intervals, management, and patient outcomes.
Main Results:
- Median diagnostic interval for Crohn's disease was 47 weeks (longer without diarrhea).
- Median diagnostic interval for ulcerative colitis was 20 weeks (5.5 weeks for severe cases).
- Significant rates of malnutrition (11%) and short stature (19% in Crohn's) were observed, correlating with symptom duration.
Conclusions:
- Late diagnosis and inappropriate investigations/management persist as major challenges.
- Children experienced unnecessary treatments and investigations in adult units.
- Delayed diagnosis significantly impacts growth impairment in pediatric IBD.
Unlabelled:
In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has increased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved clinical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's disease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paediatric gastroenterology department in the UK between 1994 and 1998. In Crohn's disease the median interval to diagnosis was 47 wk (maximum 7 y). In those without diarrhoea this was longer (66 vs 28 wk; p = 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe colitis the median interval was 5.5 wk (range 3-9 wk) and 4 required urgent colectomy soon after referral. Many with unrecognized Crohn's disease had undergone inappropriate treatments, such as growth hormone or psychiatric therapy. Nineteen (17%) had undergone endoscopic investigations in adult units prior to referral. Malnutrition was equally common in Crohn's disease and ulcerative colitis (11%). Short stature was present in 19% with Crohn's disease, and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease. There was a significant correlation between symptom duration and the degree of growth impairment present (r(s) = -0.4; p = 0.004).
Conclusion:
This study suggests that late diagnosis and inappropriate investigation and management are still significant problems.