Pre-diagnostic Clinical Presentations and Medical History Prior to the Diagnosis of Inflammatory Bowel Disease in Children

Abstract

PurposeThe clinical presentations of inflammatory bowel disease (IBD) prior to diagnosis are so diverse or vague that many of them waste time before final diagnosis. This study was undertaken to know the medical history of the pediatric patients until the final diagnosis could be reached.MethodsThe medical records of all pediatric patients who were diagnosed with IBD (Crohn's disease [CD] in 14 children, ulcerative colitis [UC] in 17) during the last 13 years were reviewed. We investigated the length of the diagnostic time lag, chief clinical presentation, and any useful laboratory predictor among the routinely performed examinations. Indeterminate colitis was not included.ResultsThe mean ages of children at the final diagnosis was similar in both diseases. As for the pre-clinical past history of bowel symptoms in CD patients, 5 were previously healthy, 9 had had 1-3 gastrointestinal (GI) symptoms, weight loss, bloody stool, anemia and rectal prolapse. With UC, 9 were previously healthy, 8 had had 1-3 GI symptoms, bloody stool, anorexia. The average diagnostic time lag with CD was 3.36 months, and with UC 2.2 months. Body mass index (BMI) and the initial basic laboratory data (white blood cell, hemoglobin, mean corpuscular volume, serum albumin, and serum total protein) were lower in CD, statistically significant only in BMI.ConclusionIBD shows diverse clinical symptoms before its classical features, making the patients waste time until diagnosis. It is important to concern possibility of IBD even in the mildly sick children who do not show the characteristic symptoms of IBD.

Artritis como debut de enfermedad inflamatoria intestinal en pediatría

“…6 El estudio de Kwon et al observó un retraso diagnóstico de 3,4 meses en los niños con EC. 7 En el primero de nuestros casos, el retraso diagnóstico fue de cuatro años. D e n t r o d e l a s m a n i f e s t a c i o n e s extraintestinales, la afectación articular es la más frecuente, tanto en los niños como en los adultos, con una incidencia del 16-33 %.…”

Anti-TNF-α treatment for post-anastomotic ulcers and inflammatory bowel disease with Crohn’s-like pathologic changes following intestinal surgery in pediatric patients

“…[6] The two main types are ulcerative colitis (UC) with contiguous mucosal and submucosal inflammation and Crohn’s disease (CD) with noncontiguous transmural inflammation. [7] IBD results in malabsorption of nutrients, failure to thrive, abdominal pain, GI bleeding and extraintestinal manifestations.…”

Color Doppler Ultrasonography and Diffusion Weighted Magnetic Resonance Enterography in Pediatric Ibd: Comparison with Histology in the Evaluation of Disease Severity

“…Inflammatory bowel diseases (IBD) are chronic, complex, multifactorial disorders which develop in genetically predisposed subjects [1]: they include Crohn's disease (CD), ulcerative colitis (UC) and indeterminate colitis (IC) [2] [3]. Several studies have reported that they are constantly on the increase [4] [5]: the prevalence of UC is 505 per 100,000 people in Europe and 249 per 100,000 in North America and of CD, 322 per 100,000 people in Europe and 319 per 100,000 in North America. Children and adolescents (aged between 0 and 18 years) account for about 25% -30% of the affected population [6].…”