Pediatr Gastroenterol Hepatol Nutr.  2013 Sep;16(3):178-184. 10.5223/pghn.2013.16.3.178.

Pre-diagnostic Clinical Presentations and Medical History Prior to the Diagnosis of Inflammatory Bowel Disease in Children

• Kwon YH
• Kim YJ

• KMID: 2051331
• DOI: http://doi.org/10.5223/pghn.2013.16.3.178

Abstract

PURPOSE
The clinical presentations of inflammatory bowel disease (IBD) prior to diagnosis are so diverse or vague that many of them waste time before final diagnosis. This study was undertaken to know the medical history of the pediatric patients until the final diagnosis could be reached.
METHODS
The medical records of all pediatric patients who were diagnosed with IBD (Crohn's disease [CD] in 14 children, ulcerative colitis [UC] in 17) during the last 13 years were reviewed. We investigated the length of the diagnostic time lag, chief clinical presentation, and any useful laboratory predictor among the routinely performed examinations. Indeterminate colitis was not included.
RESULTS
The mean ages of children at the final diagnosis was similar in both diseases. As for the pre-clinical past history of bowel symptoms in CD patients, 5 were previously healthy, 9 had had 1-3 gastrointestinal (GI) symptoms, weight loss, bloody stool, anemia and rectal prolapse. With UC, 9 were previously healthy, 8 had had 1-3 GI symptoms, bloody stool, anorexia. The average diagnostic time lag with CD was 3.36 months, and with UC 2.2 months. Body mass index (BMI) and the initial basic laboratory data (white blood cell, hemoglobin, mean corpuscular volume, serum albumin, and serum total protein) were lower in CD, statistically significant only in BMI.
CONCLUSION
IBD shows diverse clinical symptoms before its classical features, making the patients waste time until diagnosis. It is important to concern possibility of IBD even in the mildly sick children who do not show the characteristic symptoms of IBD.

Keyword

Inflammatory bowel diseases; Child

MeSH Terms

Anemia
Anorexia
Blood Cells
Body Mass Index
Child
Colitis
Colitis, Ulcerative
Erythrocyte Indices
Humans
Inflammatory Bowel Diseases
Medical Records
Rectal Prolapse
Serum Albumin
Weight Loss
Serum Albumin

Figure

• 

  Fig. 1 The distribution of body mass index (BMI) of each child. The average percentile was quite different (the 19.5 percentile for patients with Crohn's disease [CD], the 35.5 percentile for those with ulcerative colitis [UC]). Nevertheless, there was no statistical significance.

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