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Published on: September 22, 2019
[Intestinal complications and extraintestinal manifestations in children with inflammatory bowel disease]
Andrzej Stawarski1, Barbara Iwańczak, Elzbieta Krzesiek
1Akademia Medyczna we Wrocławiu, II Katedra i Klinika Pediatrii, Gastroenterologii i Zywienia. as.stawarski@poczta.onet.pl
Insights
Pediatric inflammatory bowel disease (IBD) frequently causes growth and pubertal delays. Early IBD diagnosis and management are crucial for addressing intestinal complications and extraintestinal manifestations in children.
Area of Science:
- Gastroenterology
- Pediatrics
- Immunology
Context:
- Inflammatory bowel disease (IBD) affects 15-20% of patients during childhood.
- Early-onset IBD is associated with growth delay, undernutrition, and pubertal delay, distinct from adult IBD.
- Pediatric IBD requires specialized assessment of disease-related complications.
Purpose:
- To assess the frequency and characteristics of intestinal complications (IC) and extraintestinal manifestations (EIM) in children with IBD.
- To compare IC and EIM between ulcerative colitis (UC) and Crohn disease (CD) in pediatric patients.
Summary:
- A study of 184 children (158 with UC, 26 with CD) evaluated IC and EIM.
- Crohn disease presented significantly more perianal changes, fistulae, abscesses, perforation, and ileus compared to ulcerative colitis.
- Extraintestinal manifestations were highly prevalent in both UC (50%) and CD (80%), often preceding GI symptoms, with anemia and growth delay common in CD.
Impact:
- Highlights the high prevalence of IC and EIM in pediatric IBD, impacting growth and development.
- Emphasizes that EIM can manifest before gastrointestinal symptoms, necessitating early recognition.
- Informs therapeutic strategies by underscoring the importance of considering IC and EIM in pediatric IBD management.
Unlabelled:
In 15-20% of patients with inflammatory bowel disease (IBD) the disease starts during children period. The often observed consequences of the early start of the IBD are growth delay, undernutrition and pubertal delay. These problems are specific for pediatric population, in comparison with adults IBD patients.
Aim:
The assessment of the frequency and character of intestinal complications (IC) and extraintestinal manifestations (ElM) in children with IBD (ulcerative colitis - UC and Crohn disease - CD).
Material And Methods:
The frequency and character of IC and EIM in 184 children with IBD: 158 with UC (76 boys and 82 girls) aged from 2 to 18 years, and 26 with CD (14 boys and 12 girls) aged from 2 to 18 years were assessed. The frequency of IC and EIM in both groups of children Was compared statistically (chi-square test).
Results:
Massive intestinal haemorrhage was observed in 11 children with UC. Perianal changes were present in 5 children with CD (significantly more often than in children with UC, p<0.05). External intestinal fistulae (p<0.0005), abdominal abscess, intestinal perforation and ileus (p<0.05) were characteristic complications of CD in comparison with UC. 50% of children with UC and 80% those with CD (statistically significant, p<0.005) had experienced, at least one ElM. Secondary anemia and growth delay were observed in 40,5% and 27,8% of children with UC and in 70% (p<0.05) and 80% (p<0.0001) of children with CD respectively. In children with IBD we observed also autoimmunologic hepatitis, primary sclerosing cholangitis, nephrolithiasis, pulmonary interstitial fibrosis, pancreatitis, neurological changes, skin manifestations and arthritis. Osteopenia was observed in 41% of children with CD and in 25% of children with UC. a
Conclusions:
A high prevalence of intestinal complications ane extraintestinal manifestations of IBD in pediatric population is observed. In children with IBD extraintestinal manifestations often occur before the onset of gastrointestinal symptoms. The presence of intestinal complications and extraintestinal manifestations in children with IBD should be considered during modification of therapeutic strategies.
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