Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn's Disease

被引：38

作者：

Ricciuto, Amanda ^{[1
]}

Mack, David R. ^{[2
]}

Huynh, Hien Q. ^{[3
]}

Jacobson, Kevan ^{[4
]}

Otley, Anthony R. ^{[7
]}

deBruyn, Jennifer ^{[6
]}

El-Matary, Wael ^{[5
]}

Deslandres, Colette ^{[9
]}

Sherlock, Mary E. ^{[8
]}

Critch, Jeffrey N. ^{[10
]}

Bax, Kevin ^{[11
]}

Jantchou, Prevost ^{[9
]}

Seidman, Ernest G. ^{[12
]}

Carman, Nicholas ^{[2
]}

Rashid, Mohsin ^{[7
]}

Muise, Aleixo ^{[1
]}

Wine, Eytan ^{[3
]}

Carroll, Matthew W. ^{[3
]}

Lawrence, Sally ^{[4
]}

Van Limbergen, Johan ^{[7
]}

Benchimol, Eric, I ^{[2
,13
,14
,15
,16
]}

Walters, Thomas D. ^{[1
]}

Griffiths, Anne M. ^{[1
]}

Church, Peter C. ^{[1
]}

机构：

[1] Univ Toronto, SickKids Hosp, Toronto, ON, Canada

[2] Childrens Hosp Eastern Ontario CHEO, Inflammatory Bowel Dis Ctr, Ottawa, ON, Canada

[3] Univ Alberta, Stollery Childrens Hosp, Edmonton, AB, Canada

[4] BC Childrens Hosp, Vancouver, BC, Canada

[5] Univ Manitoba, Max Rady Coll Med, Winnipeg, MB, Canada

[6] Univ Calgary, Alberta Childrens Hosp, Calgary, AB, Canada

[7] IWK Hlth Ctr, Halifax, NS, Canada

[8] McMaster Childrens Hosp, Hamilton, ON, Canada

[9] CHU St Justine, Montreal, PQ, Canada

[10] Janeway Childrens Hlth & Rehabil Ctr, St John, NF, Canada

[11] Childrens Hosp Western Ontario, London, ON, Canada

[12] Montreal Childrens Hosp, Montreal, PQ, Canada

[13] CHEO Res Inst, Ottawa, ON, Canada

[14] Univ Ottawa, Dept Pediat, Ottawa, ON, Canada

[15] Univ Ottawa, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada

[16] ICES uOttawa, Ottawa, ON, Canada

来源：

JOURNAL OF CROHNS & COLITIS | 2021年 / 15卷 / 03期

基金：

加拿大健康研究院;

关键词：

Inflammatory bowel disease [IBD; fistula; stricture; INFLAMMATORY-BOWEL-DISEASE; SYSTEMATIC EVALUATION; RISK-FACTORS; CHILDREN; OUTCOMES; SURGERY; IMPACT;

D O I：

10.1093/ecco-jcc/jjaa197

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：419 / 431

页数：13

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