[Distinct clinical characteristics of inflammatory bowel disease in children younger than 5 years]
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Published on: September 22, 2019
Barbara Iwańczak1, Anna Kofla-Dłubacz, Krystyna Mowszet
1Akademia Medyczna we Wrocławiu, II Katedra i Klinika Pediatrii, Gastroenterologii i Zywienia. barbara@iwanczak.com
Insights
Pediatric inflammatory bowel disease, including Crohn disease and ulcerative colitis, often presents with severe symptoms in children under five. Key indicators include abdominal pain, diarrhea, and fever, with most cases affecting the large intestine.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Childhood Clinical Studies
Context:
- Increasing incidence of pediatric inflammatory bowel disease (IBD), particularly Crohn disease, noted in recent decades.
- IBD diagnosis in children under five presents unique challenges in clinical assessment and management.
- Study focuses on early-onset IBD, a critical period for understanding disease progression.
Purpose:
- To assess the clinical course and disease activity of inflammatory bowel disease (IBD) in children younger than five years.
- To identify common symptoms and pathological sites in early-onset pediatric IBD.
- To evaluate the severity and treatment outcomes in this young patient cohort.
Summary:
- The study analyzed 21 children (ages 2-5) with Crohn disease, ulcerative colitis, or indeterminate colitis.
- Common symptoms included abdominal pain, diarrhea, fever, and poor thrive, with most pathology in the large intestine.
- The disease course was predominantly moderate to severe, with two colectomies performed in 3-year-olds.
Impact:
- Highlights the significant morbidity associated with early-onset IBD in young children.
- Emphasizes the need for prompt diagnosis and aggressive management strategies.
- Suggests a higher prevalence of allergies and respiratory/urinary infections in children with IBD.
Unlabelled:
In the last decades an increase in morbidity of inflammatory bowel disease, particularly of Crohn disease, in children has been observed.
Objective:
Assessment of clinical course and activity of inflammatory bowel disease in children younger than 5 years was the goal of the study.
Material And Methods:
The study comprised 21 children aged 2 to 5 years (13 boys and 8 girls) who were diagnosed with: Leśniowski-Crohn disease (7 children), ulcerative colitis (7 children) and indeterminate colitis (remaining 7 children).
Results:
Among studied children boys prevailed (61.9%). In 6 children the disease started in the first and second year of life; the average age of disease onset was 26.9 months and the time between the onset of the disease and the diagnosis was 16.6 months. 46% of patients came from the cities with population above 100000 when only 23% lived in the country. Autoimmune diseases were diagnosed in the families of 6 children, food or pollen allergy in the families of 11 children. Abdominal pain, diarrhea, presence of blood and mucous in the stool, fever and lack of thrive were most apparent in the clinical picture. The pathological changes were present mainly in the large intestine and only in one case in the upper part of the alimentary tract and jejunum. The observed course of the disease was severe or moderate. In two children aged 3 years colectomy was performed.
Conclusions:
In children younger than 5 years severe and moderate course of the Leśniowski-Crohn disease and ulcerative colitis is apparent. Fever, abdominal pain, diarrhea, presence of blood and mucous in the stool and lack of appetite were the most often seen symptoms. Pathological changes in children younger than 5 years were present mainly in the large intestine and only in single cases in the upper part of the alimentary tract and jejunum. In children with inflammatory bowel disease a frequent occurrence of allergy, bronchitis, pneumonia and urinary tract infection, which required antibiotics, was observed.
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