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Inflammatory bowel disease in children 5 years of age and younger
Petar Mamula1, Grzegorz W Telega, Jonathan E Markowitz
1Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Insights
Early onset inflammatory bowel disease (IBD) in children under five often presents with failure to thrive, particularly Crohn's disease (CD) and indeterminate colitis (IC), not ulcerative colitis (UC). Linear growth failure is common in pediatric CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Pediatrics
Background:
- Inflammatory bowel disease (IBD) affects all ages, but its presentation in infants and young children is less understood.
- Early diagnosis and characterization of IBD in pediatric populations are crucial for effective management.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of early-onset inflammatory bowel disease (IBD) in patients aged 5 years and younger.
- To differentiate between Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) in this young cohort.
Main Methods:
- Retrospective review of medical records for patients diagnosed with early-onset IBD at The Children's Hospital of Philadelphia (1977-2000).
- Categorization of patients into Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) groups.
- Analysis of clinical presentation, diagnostic changes, growth failure, disease extent, and serological markers.
Main Results:
- Of 82 patients, 15% had their IBD diagnosis revised. Linear growth failure affected 29% with CD, 3% with UC, and 18% with IC.
- Failure to thrive was common in CD (44%) and IC (39%), often leading to revised diagnoses from UC.
- Pediatric CD frequently involved the large bowel (89%) and perianal region (34%).
Conclusions:
- Failure to thrive at presentation suggests a final diagnosis of CD or IC, distinguishing it from UC in early-onset IBD.
- Linear growth failure is a significant indicator in pediatric CD.
- The IBD serology panel showed limited utility for definitive diagnosis in this pediatric cohort.
Objectives:
Clinicians are becoming increasingly aware that inflammatory bowel disease (IBD) can affect all age groups, although it has not been well described in infants and young children. Our aim was to evaluate early onset IBD in patients 5 yr of age and younger.
Methods:
Medical records of patients diagnosed with early onset IBD at The Children's Hospital of Philadelphia between 1977 and 2000 were reviewed. Patients were divided into three categories: those with Crohn's disease (CD), those with ulcerative colitis (UC), and those with indeterminant colitis (IC).
Results:
A total of 82 patients fulfilled the criteria. In 12 patients (15%), the IBD diagnosis was changed during the course of illness. At the end of the follow-up period, linear growth failure was present in 10 of 35 (29%) children with CD, one of 30 (3%) with UC, and three of 17 (18%) with IC. Failure to thrive was a frequent presenting symptom in children with CD (44%) and IC (39%), whereas in all four patients with UC and failure to thrive the diagnosis was subsequently changed to CD or IC. A high proportion of patients with CD had large bowel (89%), and perianal (34%) disease. None of the tested patients were positive for anti-Saccharomyces cerevisiae antibody (ASCA), and 10 tested positive for perinuclear antineutrophil cytoplasmic antibody (three of five patients with CD, five of seven with UC, and two of three with IC).
Conclusions:
Failure to thrive, at the time of presentation, is indicative of a final diagnosis of CD or IC, not UC. Linear growth failure is a common finding in patients with early onset CD. A high proportion of patients with CD have failure to thrive, colonic, and perianal disease. The IBD serology panel is of limited clinical relevance in providing definitive diagnostic information in this pediatric population.