Diagnostic delay in IBD tied to adverse effects in kids

Last Updated: 2017-08-25

By Rita Buckley

NEW YORK (Reuters Health) - Delays between symptom onset and diagnosis of inflammatory bowel disease (IBD) in Canadian children are associated with stunted growth, according to a new study.

Dr. Peter C. Church and colleagues from the Hospital for Sick Children in Toronto conducted a single-center prospective cohort study to determine time to diagnosis and the relative contributions of subintervals.

The cohort included 111 children, no older than 17 years and two months at recruitment, who were diagnosed with incident IBD between 2013 and 2015. Diagnostic delay was defined as "an overall time to diagnosis greater than the upper quartile," or more than 268 days.

The median overall time to diagnosis was 4.5 months, with an interquartile range (IQR) of 2.1 to 8.8. For Crohn's disease specifically, it was 6.8 months (IQR, 2.9-12.5) versus 2.4 months (IQR 1.3-5.3) in isolated small-bowel disease.

Eighty-six percent of patients diagnosed beyond one year had Crohn's disease, while 14% had ulcerative colitis (P=0.003).

Time from symptom onset to a gastroenterology referral was the greatest contributor to time to diagnosis.

Height impairment was independently associated with diagnostic delay (odds ratio, 0.59, P=0.02, for height-to-age z-score, or HAZ). This means the odds of delay increased by almost 70% for every one-standard-deviation decrease in HAZ, the researchers say; the height discrepancy persisted for one year after diagnosis.

Bloody diarrhea was independently associated with lower odds of diagnostic delay.

"This research is important," said Dr. Church, "because it sheds new light on the factors that influence the time patients wait between developing symptoms of pediatric IBD and actually getting a diagnosis from a physician."

He noted that it takes more than a year from symptom onset for a large portion of children with Crohn's disease to get a diagnosis, a delay that's associated with impaired growth that might be permanent.

Dr. Christopher Moran, an attending physician at the MassGeneral Hospital for Children in Boston, told Reuters Health by email that delay in diagnosis in a subset of patients with IBD remains a persistent problem.

"Diagnostic delays are concerning for several reasons," said Dr. Moran, who was not involved in the study. He cited ongoing struggles with gastrointestinal symptoms until diagnosis and the potential for complications, such as small-bowel obstruction due to intestinal stricturing or penetrating/fistulizing disease.

Since the disease frequently manifests in children during their pubertal years, he added, delayed diagnosis may affect bone density and pubertal growth. He cautioned, however, that the new findings may not be generalizable to all network centers or beyond the Canadian healthcare system.

Because time from symptom onset to referral is by far the largest contributor to overall time to diagnosis, "Primary care physicians, such as family doctors, general practitioners, and pediatricians, have a key role in recognizing signs of the disease and expediting referrals," Dr. Church said.

SOURCE: http://bit.ly/2wafaIA

Arch Dis Child 2017.