Diagnostic delay in Canadian children with inflammatory bowel disease is more common in Crohn’s disease and associated with decreased height

Ricciuto, Amanda; Fish, Jennifer; Tomalty, Diane; Carman, Nicholas; Crowley, Eileen; Popalis, Cynthia; Muise, Aleixo M.; Walters, Thomas D.; Griffiths, Anne M.; Church, Peter

doi:10.1136/archdischild-2017-313060

Cited by 51 publications

(63 citation statements)

References 21 publications

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“…This study was unable to comment on the prevalence of anti-TNF medication over time due to incomplete data. Data from 1998 to 2013 from Larsen et al concluded that there was decreased surgery in children with UC and a trend towards decreased surgery in CD patients over time, with a parallel increase in anti-TNF use in both groups 36. Both studies include data predating routine use of early anti-TNF therapy, and the authors conclude that analysis of more recent data may reveal a true decrease or delay in surgery during childhood alongside an increase in early anti-TNF use, as seen in our work.The assessment of growth outcomes in Crohn's disease can be used as a proxy measure of effective treatment, with improved growth reflecting adequately treated patients.…”

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confidence: 99%

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

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Summary Background Anti‐tumour necrosis factor‐α (anti‐TNF) therapy use has risen in paediatric‐onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti‐TNF‐therapy and surgery. Aim To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti‐TNF‐therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact). Results Eight‐hundred‐and‐twenty‐five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD‐unclassified), mean age at diagnosis 13.6 years (1.6‐17.6), 39.6% female. The prevalence of anti‐TNF‐treated patients increased from 5.1% to 27.1% (2007‐2017), P = 0.0001. Surgical resection‐rate fell (7.1%‐1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%‐2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection‐rates were unchanged. Time from diagnosis to resection increased (1.6‐2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007‐2011 = 13.1 years, 2013‐2017 = 11.9 years, P = 0.014). Resection‐rate in anti‐TNF‐therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti‐TNF‐therapy <3 years post‐diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti‐TNF‐therapy prevalence was the only significant predictor of resection‐rate using multivariate regression (P = 0.011). Conclusions The prevalence of anti‐TNF‐therapy increased significantly, alongside a decrease in surgical resection‐rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti‐TNF‐therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.

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confidence: 99%

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Riccuito et al analysed features associated with a delay in diagnosis. In univariate analysis diarrhoea (OR 0.29), blood per rectum (OR 0.33), bloody diarrhoea (OR 0.25) and weight loss (OR 0.38) were all significantly associated with decreased risk of a diagnostic delay, reflecting the most common symptoms seen in practice 1. The authors did not find any association between age, gender, socioeconomic background or, interestingly, a family history of IBD.…”

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confidence: 80%

“…The findings indicate that the greatest time was from onset of symptoms to referral to specialist services (89 days, IQR 48–250), with the interval between referral to specialist services and diagnosis making up a minority of the time (15 days, IQR 7–45) 1. Perhaps the most concerning finding was that 20% of patients were waiting over a year from symptoms to diagnosis 1. The results need cautious interpretation.…”

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confidence: 92%

“…The median time from symptom onset to diagnosis was 4.5 months (IQR 2.1–8.8) for all IBD and 6.8 months (IQR 2.9–12.5) for Crohn’s disease specifically 1. The diagnostic process for PIBD in the Canadian healthcare system is similar to the UK, with patients requiring referral to a specialist paediatric gastroenterologist for a diagnostic endoscopy.…”

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confidence: 95%

“…The authors analysed the time interval between symptoms and diagnosis through the relative contribution of different components of the wait (symptoms to referral to a paediatric gastroenterologist, referral to consultation, consultation to diagnostic endoscopy). The findings indicate that the greatest time was from onset of symptoms to referral to specialist services (89 days, IQR 48–250), with the interval between referral to specialist services and diagnosis making up a minority of the time (15 days, IQR 7–45) 1. Perhaps the most concerning finding was that 20% of patients were waiting over a year from symptoms to diagnosis 1.…”

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confidence: 96%

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