Current diagnosis, management and morbidity in paediatric inflammatory bowel disease

Abstract

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 (rs= 0.4; p= 0.004). Conclusion: This study suggests that late diagnosis and inappropriate investigation and management are still significant problems.

Characteristics and Trends in the Incidence of Inflammatory Bowel Disease in Korean Children: A Single-Center Experience

“…This result was similar to that of Sawczenko and Sandhu [4], who showed that only 25% of CS patients presented with the 'classic triad' and 72% with abdominal pain. In contrast to our results and those of Sawczenko and Sandhu [4], Spray et al [21] reported that most CD children presented with the classical triad. Most children with UC presented with hematochezia and diarrhea in our study; this was similar to what was seen in Western studies [4,5,21].…”

“…With UC patients, our study showed a female predominance, but the Korean adult report found no gender bias [14]. In contrast to what was seen in the Korean work, Western studies have shown no gender differences in either adults or children [4,5,21,25,26]. Further study will be required, because our patient number was small.…”

“…Male predominance was also Anal skin tag 10 (21) reported in recent Western pediatric studies [4,5,21], a report on Korean adults [14], work on South Asian children living in Canada [22], and Asian adult studies [23,24], whereas Western adult studies showed a slight female preponderance [25,26]. The same result of male predominance as ours in the Korean adults suggests that agerelated factors do not play a role in CD etiology in Korea, whereas the male:female ratio differences between adults and children in Western countries indicate that diseasetriggering aspects, or factors predisposing to pathogenesis, may differ with age.…”

Pediatric patients with inflammatory bowel disease exhibit increased serum levels of proinflammatory cytokines and chemokines, but decreased circulating levels of macrophage inhibitory protein-1β, interleukin-2 and interleukin-17

“…Often children present IBD-like phenotypes and symptoms; however, they do not suffer from IBD. A long period of unmanaged symptoms can significantly impact on growth; thus, early treatments are essential to preserve the long-term quality of life of patients (8,9).…”

Diagnostic Accuracy of Fecal Calprotectin for Pediatric Inflammatory Bowel Disease in Primary Care: A Prospective Cohort Study

“…Delay in diagnosing IBD, and the resultant delay in receipt of appropriate treatment, may prolong suffering and can lead to complications such as anemia, irreversible growth failure, and delayed sexual maturation. 4,5 According to guidelines, primary care physicians should refer children with chronic diarrhea, recurrent abdominal pain, or both for specialist care if red flags are present. 6,7 The red flags are nonspecific and discriminate poorly between functional and organic gastrointestinal diseases, [8][9][10] often leading to referral and extensive diagnostic testing.…”