Amanda Ricciuto1, David R Mack2, Hien Q Huynh3, Kevan Jacobson4, Anthony R Otley5, Jennifer deBruyn6, Wael El-Matary7, Colette Deslandres8, Mary E Sherlock9, Jeffrey N Critch10, Kevin Bax11, Prevost Jantchou8, Ernest G Seidman12, Nicholas Carman2, Mohsin Rashid5, Aleixo Muise1, Eytan Wine3, Matthew W Carroll3, Sally Lawrence4, Johan Van Limbergen5, Eric I Benchimol2,13,14,15, Thomas D Walters1, Anne M Griffiths1, Peter C Church1. 1. SickKids Hospital, University of Toronto, Toronto, ON, Canada. 2. Children's Hospital of Eastern Ontario [CHEO], Inflammatory Bowel Disease Centre, Ottawa, ON, Canada. 3. Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. 4. B.C. Children's Hospital, Vancouver, BC, Canada. 5. IWK Health Centre, Halifax, NS, Canada. 6. Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada. 7. Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 8. CHU Sainte-Justine, Montreal, QC, Canada. 9. McMaster Children's Hospital, Hamilton, ON, Canada. 10. Janeway Children's Health and Rehabilitation Centre, St. John's, NL, Canada. 11. Children's Hospital of Western Ontario, London, ON, Canada. 12. Montreal Children's Hospital, Montreal, QC, Canada. 13. CHEO Research Institute, Ottawa, ON, Canada. 14. Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 15. ICES uOttawa, Ottawa, ON, Canada.
Abstract
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.
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.
Authors: Ryszard Kubinski; Jean-Yves Djamen-Kepaou; Timur Zhanabaev; Alex Hernandez-Garcia; Stefan Bauer; Falk Hildebrand; Tamas Korcsmaros; Sani Karam; Prévost Jantchou; Kamran Kafi; Ryan D Martin Journal: Front Genet Date: 2022-02-14 Impact factor: 4.599