Diagnostic Delay Is Associated with Complicated Disease and Growth Impairment in Paediatric Crohn's Disease
| Autor: | Jennifer deBruyn, Thomas D. Walters, Colette Deslandres, Mohsin Rashid, Anne M. Griffiths, Kevan Jacobson, Eytan Wine, Kevin Bax, Jeffrey Critch, Johan Van Limbergen, Ernest G Seidman, Anthony R. Otley, Mark Sherlock, David R. Mack, Prevost Jantchou, Matthew W Carroll, Sally Lawrence, Hien Q. Huynh, Amanda Ricciuto, Eric I Benchimol, Nicholas Carman, Peter C Church, Wael El-Matary, Aleixo M. Muise |
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| Přispěvatelé: | Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, APH - Digital Health, APH - Health Behaviors & Chronic Diseases |
| Rok vydání: | 2021 |
| Předmět: |
Male
stricture medicine.medical_specialty Abdominal pain Canada Delayed Diagnosis Adolescent Inflammatory bowel disease 03 medical and health sciences 0302 clinical medicine Crohn Disease Interquartile range 030225 pediatrics Internal medicine Intestinal Fistula Medicine Humans fistula Prospective Studies Risk factor Child Growth Disorders Crohn's disease business.industry Hazard ratio Gastroenterology General Medicine Original Articles medicine.disease Ulcerative colitis 3. Good health Cohort 030211 gastroenterology & hepatology Female medicine.symptom business Inflammatory bowel disease [IBD] |
| Zdroj: | Paediatrics Publications J Crohns Colitis Journal of Crohn's & colitis, 15(3), 419-431. Elsevier |
| ISSN: | 1873-9946 |
| Popis: | Background Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay. Methods We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression. Results Overall (64% Crohn’s disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0–9.2) months. For the overall cohort, diagnostic delay was >9.2 months; in CD, >10.8 months and in UC/IBD-U, >6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41–4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005–0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay. Conclusions Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast |
| Databáze: | OpenAIRE |
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