Diagnostic delay in inflammatory bowel diseases in children

Abstract

Introduction. The incidence and prevalence of inflammatory bowel disease (IBD) in children is increasing steadily. The diagnosis is often delayed that can lead to an increased risk of complications and significantly decrease the quality of life in the child. The identification of reasons associated with prolonged diagnostics must bring down healthcare costs, reduce the frequency of surgical interventions and use of biological agents. The aim of our study was to determine the duration of diagnosis and associated factors in IBD children.
 Materials and methods. The research held at the National Medical Research Center for Children’s Health included the analysis of three hundred sixty four medical records of children diagnosed with ulcerative colitis (UC) or Crohn’s Disease (CD). This investigation assessed the time of onset of the first symptoms, the first visit to a doctor, the time of establishing the diagnosis, and the first symptoms. The diagnostic time and delay for all IBD were determined. 
 Results. The study included 286 patients, including 157 CD and 129 UC. The diagnostic delay was 18 months for CD, and 6 months for UC. The manifestation of the disease with extraintestinal symptoms in CD was found to increase the chance of a diagnosis duration of more than 18 months by 8.88 times (95% CI 3.4–23.06, p < 0.001), and in UC — more than 6 months by 4.98 times (95% CI 1.52–16.3, p = 0.009). Moreover, the absence of liquid stools, blood in the stool, low-grade fever, and abdominal pain in CD can lead to an increase in diagnostic time. It was also found that UC boys are diagnosed much longer. 
 Conclusion. CD requires more time to make a diagnosis than UC, which is due to the peculiarity of the clinical course of the di­sease. Despite the fact that a doctor has consulted patients in time, a delay in establishing a diagnosis occurred at the examination stage, so that requires additional alertness from the specialist’s side.