Presenting Symptoms and Diagnostic Lag in Children with Inflammatory Bowel Disease

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.

Inflammatory Bowel Disease in African American Children Compared With Other Racial/Ethnic Groups in a Multicenter Registry

“…Previous studies reported mean ages at diagnosis ranging from 9 to 13 years old for children with CD and UC, whereas children with IC were slightly younger (7 to 12 years old) when diagnosed 9, 16 . In our cohort, AA children were more likely to be >12 years old when diagnosed with IBD than the non-AA children.…”

“…Using dates of diagnosis in conjunction with duration of symptoms, estimated ages of IBD symptom onset in recent pediatric investigations ranged from 6 to 12 years old, irrespective of race/ethnicity 16, 18 . Among AA in our study population, symptoms of CD and UC, as well as all IBD classifications combined, appeared to begin more frequently in the teenage years (>12 years old).…”

Non-Invasive Mapping of the Gastrointestinal Microbiota Identifies Children with Inflammatory Bowel Disease

“…Diagnosis is particularly challenging in children, for whom presenting symptoms may vary widely and may only consist of subtle extra-intestinal manifestations [4]. This in turn leads to a typical delay in the diagnosis of pediatric IBD, ranging from 4 weeks in severe colitis [5] to 6–7 months in milder disease [4].…”

“…This in turn leads to a typical delay in the diagnosis of pediatric IBD, ranging from 4 weeks in severe colitis [5] to 6–7 months in milder disease [4]. Reducing this diagnostic delay is important, since a long period of unmanaged symptoms can significantly impact growth [5] and early treatment is essential to preserving long-term quality of life [6].…”

Rectal microRNAs are perturbed in pediatric inflammatory bowel disease of the colon

“…Children with IBD often experience pediatric-specific complications including growth failure and pubertal delay. The diagnosis of IBD in children is commonly delayed (2, 3), which can exacerbate these complications; the majority of children with IBD have growth failure at the time of diagnosis (4). Current therapeutic interventions are unable to permanently ameliorate symptoms and many are associated with potentially severe side effects.…”