Section of Pediatric Gastroenterology, Baylor College of Medicine, Houston, TX; Wiess School of Natural Sciences, Rice University, Houston, TX, USA.
Section of Pediatric Gastroenterology, Baylor College of Medicine, Houston, TX.
J Pediatr Surg. 2020 Mar;55(3):403-405. doi: 10.1016/j.jpedsurg.2019.03.012. Epub 2019 Mar 28.
BACKGROUND/PURPOSE: Diagnostic delay or time to diagnosis, and its relationship with colectomy risk has been studied in adult Inflammatory Bowel Disease (IBD), but rarely in pediatric IBD (PIBD), especially pediatric ulcerative colitis (P-UC), which often has a more severe course than adult UC. This study compared the relationship between diagnostic delay and colectomy in P-UC.
The medical records of P-UC patients, ages <18 years, diagnosed at Texas Children's Hospital from 2012 to 2018 were examined. We identified 106 P-UC patients, where the onset of symptoms of IBD (i.e. fever, diarrhea, blood in stool, weight loss, abdominal pain) could be clearly identified.
Twenty (20 = 18.9%) patients progressed to colectomy, and 86 did not. There was no significant difference in diagnostic delay between the patients undergoing colectomy with UC (C-UC) and those with no colectomy (NC-UC) (p = 0.2192). The median (C-UC = 7.1 weeks; NC-UC = 11.9 weeks) and mean (C-UC = 16.5 weeks±4.7; NC-UC = 20.1 ± 2.6) diagnostic delay actually tended to be shorter in C-UC compared to NC-UC. Fecal calprotectin levels were significantly higher (p = 0.0228) in C-UC than NC-UC patients at diagnosis.
Shorter time to diagnosis may reflect disease severity at the time of disease onset and also a more aggressive subsequent course of P-UC. The significantly higher level of fecal calprotectin in the C-UC patients at diagnosis provided biologic/biochemical support for our conclusion.
Prognosis study, Level III evidence.
背景/目的：在成人炎症性肠病（IBD）中，已经研究了诊断延迟或诊断时间与结肠切除术风险之间的关系，但在儿科炎症性肠病（PIBD）中很少研究，特别是儿科溃疡性结肠炎（P-UC），其通常比成人 UC 更严重。本研究比较了 P-UC 中诊断延迟与结肠切除术的关系。
检查了 2012 年至 2018 年在德克萨斯儿童医院诊断的年龄<18 岁的 P-UC 患者的病历。我们确定了 106 名 P-UC 患者，他们的 IBD 症状（即发烧、腹泻、大便带血、体重减轻、腹痛）可以明确识别。
20 名（20=18.9%）患者进展为结肠切除术，86 名患者未进展。行结肠切除术的 UC 患者（C-UC）与未行结肠切除术的 UC 患者（NC-UC）之间的诊断延迟无显著差异（p=0.2192）。C-UC 的中位（C-UC=7.1 周；NC-UC=11.9 周）和平均（C-UC=16.5 周±4.7；NC-UC=20.1±2.6）诊断延迟实际上倾向于比 NC-UC 更短。C-UC 患者的粪便钙卫蛋白水平显著高于 NC-UC 患者（p=0.0228）。
诊断时间更短可能反映了发病时疾病的严重程度，也反映了 P-UC 后续更具侵袭性的病程。C-UC 患者的粪便钙卫蛋白水平显著升高，为我们的结论提供了生物学/生物化学支持。
预后研究，III 级证据。
