Inflammatory bowel disease in childhood. Presentation and diagnosis

150 patients whose first symptoms of inflammatory bowel disease (IBD) presented before puberty were seen at this hospital between 1955 and 1979. Ulcerative colitis with the rectum less severely involved than the colon was commoner than usually reported in adults. Colectomy with ileorectal anastomosis allowed these children to go through school life and adolescence without an ileostomy. Failure of medical treatment was much commoner in those presenting with already total colonic involvement. Children with Crohn's disease were twice as likely to come to surgery within the first five years of illness than those with ulcerative colitis. Delayed diagnosis (mean 2.6 years) was much greater in Crohn's disease, especially in the 25% presenting initially with failure to thrive and no specifically alimentary symptoms.