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Slow IBD diagnosis in children leads to more advanced disease
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Slow diagnosis of inflammatory bowel disease in pediatric patients was associated with advanced bowel involvement at the time of diagnosis, according to recent data.
“Time from symptom onset to diagnosis for IBD among children and adolescents is too long: an average of 4 to 6 months,” the researchers wrote. “The majority of pediatric IBD patients already have extensive involvement at diagnosis.”
With respect to the patients’ age group (younger than 10 years vs. aged at least 10 years), symptoms (abdominal pain, diarrhea, blood in stool, failure to gain weight/weight loss, etc), family history and disease phenotype, researchers compared patient care with guidelines provided by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The data were extracted from a registry that collects information from multiple medical centers in Germany and Austria.
Of the 958 patients included in the analysis, 64.3% were diagnosed with Crohn’s disease and 29% with ulcerative colitis.
According to the results, diagnosis was slower in patients who ultimately had CD compared with patients with UC (0.5 years vs. 0.3 years).
Phenotyping for CD was assessed in the 480 patients with recorded ileocolonoscopy, esophagogastroduodenoscopy and small intestine imaging. Among those patients, lesions affected 62.5% of patients’ ileum and colon and 59% in the esophagus, stomach or upper small intestine.
In patients with UC, 75% had extensive colitis or pancolitis at the time of diagnosis.
However, when evaluating patient care against recommended guidelines, adherence to the guidelines steadily increased between 2004-2005 and 2014.
Imaging of the small intestine increased in compliance with guidelines from 41.2% (95% CI, 33.6-49.1) to 60.9% (95% CI, 38.5-80.3). Likewise, ileocolonoscopy and esophagogastroduodenoscopy procedures increased from 69% in 2004-2005 to 100% by 2013-2014.
“The registry data imply that improvement in clinical course may be achieved by shortening the time to diagnosis and by closer adherence to the diagnostic and therapeutic guidelines,” the researchers concluded. – by Stephanie Viguers
Disclosure: Buderus reports various financial ties with AbbVie, Merck Sharp & Dohme and Nestlé. Please see the full study for a list of all other authors’ relevant financial disclosures.
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