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Updated: Jun 30, 2025
Investigating Intestinal Inflammation in DSS-induced Model of IBD
Published on: February 1, 2012
Diagnosis change in pediatric inflammatory bowel disease
Harold Duarte1,2, Adrienne Stolfi2, Courtney McCall2
1Department of Internal Medicine, Kettering Health Main Campus, Kettering, Ohio, USA.
Insights
Pediatric inflammatory bowel disease (IBD) diagnosis changes occurred in 6.1% of patients, most commonly from IBD-Unclassified to Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD), ulcerative colitis (UC), and IBD-Unclassified (IBD-U).
- Accurate diagnosis in pediatric IBD is crucial for effective management and treatment.
- Diagnostic uncertainty can lead to changes in diagnosis over time, particularly in the early stages of the disease.
Purpose of the Study:
- To characterize pediatric IBD patients who experience a change in their diagnosis.
- To describe the specific characteristics and patterns associated with these diagnostic shifts.
Main Methods:
- Retrospective analysis of a large, multicenter international pediatric IBD cohort (ImproveCareNow) from 2007 to 2019.
- Inclusion of 18,055 patients aged 1-20 years.
- Primary outcome: change in diagnosis after the first four visits; analysis of demographics, diagnostics, disease characteristics, and timing.
Main Results:
- 6.1% of pediatric IBD patients changed diagnosis, with a median time to change of 0.9 years.
- Diagnosis change rates varied significantly: 2.1% for CD, 7.3% for UC, and 44.2% for IBD-U.
- Initial diagnosis of IBD-U and longer follow-up times were independently associated with a higher likelihood of diagnosis change.
Conclusions:
- Initial diagnosis of IBD-Unclassified and extended follow-up increase the risk of diagnostic change in pediatric IBD.
- The most frequent diagnostic transition observed was from IBD-Unclassified to Crohn's disease.
- Disease activity, malnutrition, and extraintestinal manifestations (EIMs) were not found to be associated with diagnosis changes.
Objectives:
This study aims to characterize pediatric inflammatory bowel disease (IBD) patients who change diagnosis and describe the characteristics of that change.
Methods:
A retrospective study was conducted on pediatric IBD patients from the ImproveCareNow (ICN) multicenter international cohort from 2007 to January 2019. Primary outcome was change in diagnosis after the first four visits. Other variables included demographics, diagnostics, disease characteristics, and timing.
Results:
6.1% of 18,055 patients aged 1-20 years changed diagnosis. Median time between the baseline visit and first diagnosis change was 0.9 years. Change in diagnosis occurred in 257/12,178 (2.1%) patients with Crohn's disease (CD), 347/4758 (7.3%) patients with ulcerative colitis (UC), and 495/1119 (44.2%) patients with IBD-Unclassified (IBD-U). In multivariable analysis, initial diagnosis of IBD-U and longer follow-up times were associated with greater odds of a diagnosis change.
Conclusion:
IBD-U initial diagnosis and longer follow-up were associated with increased diagnosis change risk. The most common change was reclassification to CD. Disease activity, moderate malnutrition, and presence of EIMs were not associated with change in diagnosis.
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