Chronic inflammatory bowel disease in childhood: Clinical presentation and reasons of delay in diagnosis

The incidence of Chronic Inflammatory Bowel Disease in the mediterranean area is still unknown. Only few preliminary reports suggest that the incidence of Chronic Inflammatory Bowel Disease in Italy has increased during the last years and is now very near to the incidence reported in the anglo-saxon countries (i.e.: 6-12.5/100.000/year). The proportion of Chronic Inflammatory Bowel Disease becoming symptomatic during childhood and adolescence is to be considered as ranging between 15% and 30%, whatever the people or country. Therefore it is very surprising that no series regarding Chronic Inflammatory Bowel Disease in pediatric age have been found in the medical and surgical italian literature. We report our experience with 30 patients (Ulcerative Colitis =18 cases, Undefined Colitis=1 case, Crohn's Disease=11 cases). 24/30 patients (80%) were diagnosed between 1981 and 1988, whereas only 6/30 before 1981. This reflects the increasing attention which has been paid to this illness. In most cases ulcerative colitis represented not a clinical dilemma and ine delay in diagnosis was reasonnably short; signs and symptoms are, on the other nand, the same in childhood and adulthood. The response to medical therapy was good and only two patients needed a surgical procedure. Crohn's disease may instead have a long standing insidious onset; extraintestinal manifestations may predominate over the intestinal symptoms, with a great delay in the diagnosis, which was more than 10 years in one patient. More than 50% of the patients underwent surgical procedure. Resection of the diseased bowel resulted in significant weight gain. When growth retardation is the main complication of Crohn's disease, surgical treatment offers best results than a prolonged medical therapy (enteral and/or parenteral nutrition, steroids). The possible reasons of the diagnostic delay in both diseases are discussed.