rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2023-26-6-399-407nkdaxerosped-378Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSДиагностическая задержка при воспалительных заболеваниях кишечника у детейDiagnostic delay in inflammatory bowel diseases in childrenhttps://orcid.org/0000-0002-1198-0396ПрохоренковаМарина ОлеговнаProkhorenkovaMarina O.

Ассистент, каф. педиатрии и детской ревматологии Клинического института детского здоровья им. Н.Ф. Филатова ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

e-mail: prokhorenkova_m_o@staff.sechenov.ru

 

Assistant lecturer of the Department of Pediatrics and Pediatric Rheumatology, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, Moscow, Russian Federation

e-mail: prokhorenkova_m_o@staff.sechenov.ru

prokhorenkova_m_o@staff.sechenov.ruhttps://orcid.org/0000-0003-1427-403XНосенкоКристина МаксимовнаNosenkoKristina M.

Ординатор, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

noemail@neicon.ruhttps://orcid.org/0009-0000-3611-0293ОрловаМария АлексеевнаOrlovaMariya A.

Студент, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

noemail@neicon.ruhttps://orcid.org/0000-0002-3977-0657ВинокуроваАнна ВалерьевнаVinokurovaAnna V.

Аспирант гастроэнтерологического отделения, ФГАУ «НМИЦ здоровья детей» Мин­здрава России

noemail@neicon.ruhttps://orcid.org/0009-0001-6524-4474КазаковаВлада АлександровнаKazakovaVlada A.

Студент, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

noemail@neicon.ruhttps://orcid.org/0009-0003-2994-8321КоролёваОльга АлександровнаKorolevaOlga A.

Студент, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

noemail@neicon.ruhttps://orcid.org/0009-0009-1930-1704ДороговАнтон ЮрьевичDorogovAnton Yu.

Ординатор, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

noemail@neicon.ruhttps://orcid.org/0000-0003-4905-2373ПотаповАлександр СергеевичPotapovAlexandr S.

Доктор мед. наук, проф., начальник центра воспалительных заболеваний кишечника у детей, зав. гастроэнтерологическим отделением ФГАУ «НМИЦ здоровья детей» Минздрава России; проф. каф. педиатрии и детской ревматологии Клинического института детского здоровья им. Н.Ф. Филатова ФГАОУ ВО «Первого МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)

noemail@neicon.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет)I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава РоссииNational Medical Research Center for Children’s HealthФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет); ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава РоссииI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); National Medical Research Center for Children’s Health202306012024266399407Copyright © Прохоренкова М.О., Носенко К.М., Орлова М.А., Винокурова А.В., Казакова В.А., Королёва О.А., Дорогов А.Ю., Потапов А.С., 20242024Прохоренкова М.О., Носенко К.М., Орлова М.А., Винокурова А.В., Казакова В.А., Королёва О.А., Дорогов А.Ю., Потапов А.С.Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Vinokurova A.V., Kazakova V.A., Koroleva O.A., Dorogov A.Y., Potapov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rosped.ru/jour/article/view/378Введение

Введение. Заболеваемость и распространённость воспалительных заболеваний кишечника (ВЗК) у детей неуклонно увеличиваются. Однако диагноз ВЗК часто устанавливается с определённой задержкой, что может привести к повышению риска развития осложнений и снижает качество жизни ребёнка. Выявление причин диагностической задержки при ВЗК у детей направлено на уменьшение затрат здравоохранения, частоты осложнений и их хирургического лечения, а также использования генно-инженерных биологических препаратов.

Цель

Цель: определить причины диагностической задержки у детей с ВЗК и связанные с ней факторы.

Материалы и методы

Материалы и методы. Проведён анализ 364 историй болезни детей с язвенным колитом (ЯК) и болезнью Крона (БК). Обследовано 286 пациентов: 157 детей с БК, 129 — c ЯК. У всех больных определяли время появления первых симптомов ВЗК и обращения к врачу, сроки постановки диагноза и первые симптомы, общее время диагностики и длительность диагностической задержки для всех форм ВЗК.

Результаты

Результаты. Задержка установления диагноза составила при БК 18 мес, при ЯК — 6 мес. Манифестация заболевания с внекишечных симптомов при БК увеличивает шанс длительности постановки диагноза более 18 мес в 8,88 раза (95% ДИ 3,4–23,06; p < 0,001), а при ЯК более 6 мес — в 4,98 раза (95% ДИ 1,52–16,3; p = 0,009). При этом отсутствие жидкого стула, примеси крови в стуле, субфебрильной температуры, боли в животе у детей с БК могут приводить к увеличению длительности диагностики. При ЯК у мальчиков диагноз ставится дольше.

Заключение

Заключение. БК у детей требует больше времени для постановки диагноза, чем ЯК, что обусловлено особенностями клинического течения этих болезней. Несмотря на то что пациенты обращаются к врачу вовремя, задержка в постановке диагноза происходит на стадии обследования, что требует высокой квалификации и дополнительной настороженности со стороны специалистов.

Участие авторов

Участие авторов:Потапов А.С., Прохоренкова М.О., Носенко К.М. — концепция и дизайн исследования;Прохоренкова М.О., Носенко К.М., Орлова М.А., Казакова В.А., Дорогов А.Ю. — сбор и обработка материала;Прохоренкова М.О., Носенко К.М., Орлова М.А., Королева О.А. — статистическая обработка;Прохоренкова М.О., Носенко К.М., Орлова М.А., Казакова В.А., Королева О.А., Винокурова А.В. — написание текста;Потапов А.С., Прохоренкова М.О. — редактирование.Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 10

Поступила 10.11.2023Принята к печати 28.11.2023Опубликована 27.12.2023

 

 

Introduction

Introduction. The incidence and prevalence of inflammatory bowel disease (IBD) in children is increasing steadily. The diagnosis is often delayed that can lead to an increased risk of complications and significantly decrease the quality of life in the child. The identification of reasons associated with prolonged diagnostics must bring down healthcare costs, reduce the frequency of surgical interventions and use of biological agents.

The aim of our study was to determine the duration of diagnosis and associated factors in IBD children.

Materials and methods

Materials and methods. The research held at the National Medical Research Center for Children’s Health included the analysis of three hundred sixty four medical records of children diagnosed with ulcerative colitis (UC) or Crohn’s Disease (CD). This investigation assessed the time of onset of the first symptoms, the first visit to a doctor, the time of establishing the diagnosis, and the first symptoms. The diagnostic time and delay for all IBD were determined.

Results

Results. The study included 286 patients, including 157 CD and 129 UC. The diagnostic delay was 18 months for CD, and 6 months for UC. The manifestation of the disease with extraintestinal symptoms in CD was found to increase the chance of a diagnosis duration of more than 18 months by 8.88 times (95% CI 3.4–23.06, p < 0.001), and in UC — more than 6 months by 4.98 times (95% CI 1.52–16.3, p = 0.009). Moreover, the absence of liquid stools, blood in the stool, low-grade fever, and abdominal pain in CD can lead to an increase in diagnostic time. It was also found that UC boys are diagnosed much longer.

Conclusion

Conclusion. CD requires more time to make a diagnosis than UC, which is due to the peculiarity of the clinical course of the di­sease. Despite the fact that a doctor has consulted patients in time, a delay in establishing a diagnosis occurred at the examination stage, so that requires additional alertness from the specialist’s side.

Contribution

Contribution:Potapov A.S., Prokhorenkova M.O., Nosenko K.M. — research concept and design of the study;Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Kazakova V.A., Dorogov A.Yu. —collection and processing of material;Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Koroleva O.A. — statistical processing;Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Kazakova V.A., Koroleva O.A., Vinokurova A.V. — writing the text;Potapov A.S., Prokhorenkova M.O. — editing the text.All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: November 10, 2023Accepted: November 28, 2023Published: December 27, 2023

 

 

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The authors declare that there are no conflicts of interest present.