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Diagnostic delay and colectomy risk in pediatric ulcerative colitis
Mahesh Krishna1, Savini Britto2, Justin Qian2
1Section of Pediatric Gastroenterology, Baylor College of Medicine, Houston, TX; Wiess School of Natural Sciences, Rice University, Houston, TX, USA.
Insights
Shorter diagnostic delay in pediatric ulcerative colitis (P-UC) may indicate more severe disease and a higher risk of colectomy. Higher fecal calprotectin levels at diagnosis support this finding in P-UC patients requiring colectomy.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Prognosis Studies
Background:
- Diagnostic delay in pediatric Inflammatory Bowel Disease (PIBD), particularly pediatric ulcerative colitis (P-UC), is understudied compared to adults.
- P-UC often presents with a more severe disease course than adult ulcerative colitis (UC).
Purpose of the Study:
- To investigate the relationship between diagnostic delay and the risk of colectomy in pediatric ulcerative colitis (P-UC).
- To compare diagnostic delay in P-UC patients who underwent colectomy versus those who did not.
Main Methods:
- Retrospective review of medical records for 106 P-UC patients (<18 years) diagnosed between 2012 and 2018.
- Identification of symptom onset to diagnosis time (diagnostic delay) and colectomy status.
- Analysis of fecal calprotectin levels at diagnosis.
Main Results:
- No statistically significant difference in diagnostic delay between patients who underwent colectomy (C-UC) and those who did not (NC-UC).
- A trend towards shorter diagnostic delay in C-UC patients (median 7.1 weeks) compared to NC-UC patients (median 11.9 weeks).
- Significantly higher fecal calprotectin levels were observed in C-UC patients at diagnosis (p=0.0228).
Conclusions:
- Shorter diagnostic delay in P-UC may correlate with increased disease severity at onset and a more aggressive disease course.
- Elevated fecal calprotectin levels at diagnosis provide biochemical evidence supporting the link between disease severity and colectomy risk in P-UC.
Background/Purpose:
Diagnostic delay or time to diagnosis, and its relationship with colectomy risk has been studied in adult Inflammatory Bowel Disease (IBD), but rarely in pediatric IBD (PIBD), especially pediatric ulcerative colitis (P-UC), which often has a more severe course than adult UC. This study compared the relationship between diagnostic delay and colectomy in P-UC.
Methods:
The medical records of P-UC patients, ages <18 years, diagnosed at Texas Children's Hospital from 2012 to 2018 were examined. We identified 106 P-UC patients, where the onset of symptoms of IBD (i.e. fever, diarrhea, blood in stool, weight loss, abdominal pain) could be clearly identified.
Results:
Twenty (20 = 18.9%) patients progressed to colectomy, and 86 did not. There was no significant difference in diagnostic delay between the patients undergoing colectomy with UC (C-UC) and those with no colectomy (NC-UC) (p = 0.2192). The median (C-UC = 7.1 weeks; NC-UC = 11.9 weeks) and mean (C-UC = 16.5 weeks±4.7; NC-UC = 20.1 ± 2.6) diagnostic delay actually tended to be shorter in C-UC compared to NC-UC. Fecal calprotectin levels were significantly higher (p = 0.0228) in C-UC than NC-UC patients at diagnosis.
Conclusions:
Shorter time to diagnosis may reflect disease severity at the time of disease onset and also a more aggressive subsequent course of P-UC. The significantly higher level of fecal calprotectin in the C-UC patients at diagnosis provided biologic/biochemical support for our conclusion.
Levels Of Evidence:
Prognosis study, Level III evidence.
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