Current diagnosis, management and morbidity in paediatric inflammatory bowel disease

In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has incr eased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved cli nical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's di sease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paedia tric gastroenterology department in the UK between 1994 and 1998. In Crohn' s disease the median interval to diagnosis was 47 wk (maximum 7 y). In thos e without diarrhoea this was longer (66 vs 28 wk; p = 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe coliti s the median interval was 5.5 wk (range 3-9 wk) and 4 required urgent colec tomy soon after referral. Many with unrecognized Crohn's disease had underg one inappropriate treatments, such as growth hormone or psychiatric therapy . Nineteen (17%) had undergone endoscopic investigations in adult units pri or to referral. Malnutrition was equally common in Crohn's disease and ulce rative colitis (11%). Short stature was present in 19% with Crohn's disease . and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease . There was a significant correlation between symptom duration and the degr ee of growth impairment present (r(s) = -0.4: p = 0.004). Conclusion: This study suggests that late diagnosis and inappropriate inves tigation and management are still significant problems.