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Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease
Johan Van Limbergen1, Richard K Russell, Hazel E Drummond
1Gastrointestinal Unit, Molecular Medicine Centre, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom. johanvanlimbergen@hotmail.com
Insights
Childhood-onset inflammatory bowel disease (IBD) presents with more extensive intestinal involvement and progresses more rapidly than adult-onset IBD. Early diagnosis and treatment are crucial for managing this aggressive disease in children.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Immunology
Background:
- Childhood-onset inflammatory bowel disease (IBD) may have distinct etiological factors compared to adult-onset IBD.
- Understanding the differences in disease phenotype and progression is crucial for effective management.
Purpose of the Study:
- To analyze and compare the disease phenotypes and progression of childhood-onset IBD with adult-onset IBD in Scottish patients.
- To identify key differences in disease characteristics, extent, and complications between pediatric and adult IBD cohorts.
Main Methods:
- Utilized the Montreal classification to assess anatomic locations and behaviors in 416 childhood-onset IBD patients and 1297 adult-onset IBD patients.
- Analyzed data on Crohn's disease (CD), ulcerative colitis (UC), and IBD unclassified (IBDU) diagnosed before age 17 for childhood-onset cases.
Main Results:
- Childhood-onset Crohn's disease frequently presented as a "panenteric" phenotype (ileocolonic plus upper GI involvement), unlike adult-onset disease.
- Ulcerative colitis was more extensive at diagnosis and during follow-up in children compared to adults.
- Children with IBD showed rapid progression of disease extent and development of complications within the first few years of diagnosis, requiring early immunomodulatory therapy.
Conclusions:
- Childhood-onset IBD is characterized by extensive intestinal involvement and rapid early progression.
- These findings highlight the aggressive nature of pediatric IBD and the need for tailored treatment strategies.
Background & Aims:
Childhood-onset inflammatory bowel disease (IBD) might be etiologically different from adult-onset IBD. We analyzed disease phenotypes and progression of childhood-onset disease and compared them with characteristics of adult-onset disease in patients in Scotland.
Methods:
Anatomic locations and behaviors were assessed in 416 patients with childhood-onset (276 Crohn's disease [CD], 99 ulcerative colitis [UC], 41 IBD type unclassified [IBDU] diagnosed before seventeenth birthday) and 1297 patients with adult-onset (596 CD, 701 UC) IBD using the Montreal classification.
Results:
At the time of diagnosis in children, CD involved small bowel and colon (L3) in 51% (138/273), colon (L2) in 36%, and ileum (L1) in 6%; the upper gastrointestinal (GI) tract (L4) was also affected in 51%. In 39%, the anatomic extent increased within 2 years. Behavioral characteristics progressed; 24% of children developed stricturing or penetrating complications within 4 years (vs 9% at diagnosis; P < .0001; odds ratio [OR], 3.32; 95% confidence interval [CI], 1.86-5.92). Compared with adults, childhood-onset disease was characterized by a "panenteric" phenotype (ileocolonic plus upper GI [L3+L4]; 43% vs 3%; P < .0001; OR, 23.36; 95% CI, 13.45-40.59) with less isolated ileal (L1; 2% vs 31%; P < .0001; OR, 0.06; 95% CI, 0.03-0.12) or colonic disease (L2; 15% vs 36%; P < .0001; OR, 0.31; 95% CI, 0.21-0.46). UC was extensive in 82% of the children at diagnosis, versus 48% of adults (P < .0001; OR, 5.08; 95% CI, 2.73-9.45); 46% of the children progressed to develop extensive colitis during follow-up. Forty-six percent of children with CD and 35% with UC required immunomodulatory therapy within 12 months of diagnosis. The median time to first surgery was longer in childhood-onset than adult-onset patients with CD (13.7 vs 7.8 years; P < .001); the reverse was true for UC.
Conclusions:
Childhood-onset IBD is characterized by extensive intestinal involvement and rapid early progression.
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