AccScience Publishing / JCTR / Online First / DOI: 10.36922/JCTR025360059
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ORIGINAL ARTICLE

Diagnostic delay in very early-onset inflammatory bowel disease: A tertiary single-center retrospective study

Juliana Tedesco Dias1 ,  Debora Avellaneda Penatti1 ,  Jessika Alves de Souza Costa1 ,  Gabriela Nascimento Hercos1 ,  Carine Dias Ferreira de Jesus1 ,  Mary de Assis Carvalho1 ,  Nilton Carlos Machado1*
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1 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
JCTR, 025360059 https://doi.org/10.36922/JCTR025360059
Received: 2 September 2025 | Revised: 21 November 2025 | Accepted: 4 December 2025 | Published online: 16 December 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Very early-onset inflammatory bowel disease (VEO-IBD) may have an aggressive clinical course. Upon suspicion, an immediate transfer to a pediatric gastroenterology clinic should be made, considering that diagnostic delay (DD) in referral can have profound implications. Objectives: The objectives of the study are to investigate the time, proportion, and factors associated with DD in VEO-IBD and explore the symptoms at initial presentation. Methods: An observational, retrospective, single-center study of consecutive patients with VEO-IBD confirmed by histopathology was conducted. We measured the time to diagnosis—the interval between symptom onset and the final VEO-IBD diagnosis. DD was defined as the time to diagnosis that exceeded the 75th percentile. Results: Twenty-five children with VEO-IBD—16 with ulcerative colitis (UC) and 9 with Crohn’s disease (CD)—were evaluated, with a median age of 34 months. Ages at first symptoms, first visit, and diagnosis were significantly lower for the CD group. However, there was no significant difference in the time from first symptoms to diagnosis between CD and UC. Patients with weight loss, anemia, and fistulas did not meet established criteria for DD and were referred early. Conclusion: Our study underscores the importance of early recognition of VEO-IBD, with bloody diarrhea, abdominal pain, and weight loss serving as crucial warning signs. Identifying these symptoms can aid in the early diagnosis and prompt referral to a specialist, potentially reducing the risk of DD. Relevance for patients: Early recognition of bloody diarrhea, abdominal pain, and weight loss in young children can speed diagnosis of VEO-IBD and ensure timely referral to specialist care.

Keywords
Very early-onset inflammatory bowel disease
Diagnostic delay
Crohn’s Disease
Ulcerative colitis
Diarrhea
Blood in stools
Abdominal pain
Weight loss
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
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