TY - JOUR
T1 - Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn's Disease
AU - Ricciuto, Amanda
AU - Mack, David R.
AU - Huynh, Hien Q.
AU - Jacobson, Kevan
AU - Otley, Anthony R.
AU - deBruyn, Jennifer
AU - el-Matary, Wael
AU - Deslandres, Colette
AU - Sherlock, Mary E.
AU - Critch, Jeffrey N.
AU - Bax, Kevin
AU - Jantchou, Prevost
AU - Seidman, Ernest G.
AU - Carman, Nicholas
AU - Rashid, Mohsin
AU - Muise, Aleixo
AU - Wine, Eytan
AU - Carroll, Matthew W.
AU - Lawrence, Sally
AU - van Limbergen, Johan
AU - Benchimol, Eric I.
AU - Walters, Thomas D.
AU - Griffiths, Anne M.
AU - Church, Peter C.
N1 - Funding Information: This work was supported by grant 297862 from the Canadian Institutes of Health Research [CIHR] in partnership with the Children's Intestinal and Liver Disease [Ch.I.L.D.] Foundation. EIB was supported by a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology, and Crohn's and Colitis Canada. EIB was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Publisher Copyright: © 2020 The Author(s). Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - 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.
AB - 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.
KW - Inflammatory bowel disease [IBD]
KW - fistula
KW - stricture
UR - http://www.scopus.com/inward/record.url?scp=85099241098&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ecco-jcc/jjaa197
DO - https://doi.org/10.1093/ecco-jcc/jjaa197
M3 - Article
C2 - 32978629
SN - 1873-9946
VL - 15
SP - 419
EP - 431
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
IS - 3
ER -