Diagnostic delay in Crohn's disease

Abstract

The interval between the onset of symptoms and confirmation of the diagnosis of Crohn's disease in children is often many months or years. A number of factors contribute to this diagnostic delay, but the most significant appear to be delay in the patient seeking initial medical help and failure of the medical practitioner to consider the diagnosis at the time of the first medical contact. In this review of 55 children with Crohn's disease the intervals between onset of symptoms, first presentation and diagnosis were examined and the causes of diagnostic delay determined. The main reason a diagnosis was not made at first presentation was because of ignorance of the fact that Crohn's disease could occur in children. In older children, the combination of tiredness, lethargy and iron deficiency anaemia with vague or intermittent abdominal pain was a frequent cause of diagnostic difficulty. However, even in the absence of major gastrointestinal symptoms, the significance of growth failure and delayed puberty was usually recognised if the patient was referred to a paediatrician. Diagnostic delay could well be reduced if medical practitioners involved in the primary care of children were educated to recognise the various ways in which Crohn's disease presents in this age group.