TOPLINE

Inappropriate diagnostic pathways that bypassed primary care or specialist evaluation were noted in about 60% of patients with paediatric inflammatory bowel disease (pIBD). Severe intestinal symptoms were independently associated with appropriate pathways, whereas systemic and extraintestinal signs showed a weaker association.

METHODOLOGY

• Researchers conducted a retrospective, observational study to evaluate diagnostic pathway appropriateness in pIBD and determine key predictors of both pathway appropriateness and diagnostic delay.
• They included 128 patients with pIBD (median age at diagnosis, 12.4 years) from a centre in Italy between 2015 and 2025.
• Diagnostic pathways were categorised as appropriate if they included primary care evaluation, screening, and direct gastroenterology referral or urgent referral for severe presentations; partially appropriate if they included appropriate evaluation but followed indirect referral routes or direct referral with delayed screening after gastroenterologist evaluation; or inappropriate if they bypassed primary care or specialist evaluation.
• First‐line evaluation comprised a faecal calprotectin (FC) test, with positivity defined as FC levels > 50 mg/kg; and abdominal ultrasound (AUS), with positivity defined as bowel wall thickening of at least 3 mm.
• Diagnostic delay represented the interval between the onset of symptoms and endoscopic confirmation of diagnosis.

TAKEAWAY

• Pathways were inappropriate in 60.9% of patients, partially appropriate in 21.9%, and appropriate in only 17.2%. Simultaneous FC and AUS testing was performed in 32.8% of patients.
• In the multivariate model, factors independently predicting appropriate vs inappropriate diagnostic pathways were acute severe colitis (adjusted odds ratio [aOR], 32.2; P = .01) and tenesmus (aOR, 5.8; P = .04).
• Fever (aOR, 0.10; P = .02) and oral aphthosis (aOR, 0.05; P = .04) showed a weaker association with partially and fully appropriate diagnostic pathways, respectively, than with inappropriate diagnostic pathways.
• Overall, the median diagnostic delay was 3.9 months. Acute severe colitis (P = .04), haematochezia (P = .04), weight loss (P = .04), and fever (P = .01) were independently associated with shorter delays, whereas older age at diagnosis was associated with longer delays (P = .024).

IN PRACTICE

"Standardizing screening practices and referral criteria are essential to optimize early diagnosis and improve outcomes in patients with pIBD," the authors wrote.

SOURCE

The study was led by Francesca Borgiani, Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy. It was published online on September 21, 2026, in the Journal of Pediatric Gastroenterology and Nutrition.

LIMITATIONS

The study was retrospective in nature and conducted at a single centre, which may have limited the applicability of the findings. The possibility of documentation bias could not be ruled out because pathway reconstruction and the assessment of the severity of disease depended on retrospective medical records.

DISCLOSURES

This study did not report any specific funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.