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Published on: September 22, 2019
Extraintestinal manifestations of pediatric inflammatory bowel disease and their relation to disease type and
Jennifer L Dotson1, Jeffrey S Hyams, James Markowitz
1Nationwide Children's Hospital, Columbus, OH 43205, USA. jennifer.dotson@natiowidechildrens.org
Insights
Extraintestinal manifestations (EIMs) affect about a quarter of pediatric inflammatory bowel disease (IBD) patients, often appearing within the first year. Increased disease severity is linked to a higher incidence of EIMs in children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Extraintestinal manifestations (EIMs) are common in pediatric inflammatory bowel disease (IBD).
- Limited research exists on EIM rates and associated factors in pediatric IBD populations.
- Understanding EIMs is crucial for comprehensive IBD management in children.
Purpose of the Study:
- To determine the incidence rates of EIMs in pediatric IBD patients.
- To investigate correlations between EIMs and patient demographics, diagnosis, disease severity, and distribution.
- To provide insights into the clinical course of EIMs in children with IBD.
Main Methods:
- Prospective data collection from the Pediatric IBD Collaborative Research Group Registry.
- Inclusion of newly diagnosed IBD patients under 16 years old since 2002.
- Exclusion of patients with indeterminate colitis; analysis focused on Crohn disease and ulcerative colitis.
Main Results:
- 28.2% of 1,009 pediatric IBD patients experienced at least one EIM, with 87% occurring within the first year.
- Increased disease severity at baseline was significantly associated with the occurrence of any EIM, arthralgia, aphthous stomatitis, and erythema nodosum.
- Statistically significant differences in EIM rates between Crohn disease and ulcerative colitis were observed for aphthous stomatitis, erythema nodosum, and sclerosing cholangitis.
Conclusions:
- Approximately one-quarter of pediatric IBD patients develop EIMs as defined in this study.
- Disease type and severity are significant factors associated with the occurrence of EIMs in pediatric IBD.
- These findings highlight the importance of monitoring for EIMs in children diagnosed with IBD.
Objectives:
Although it is known that extraintestinal manifestations (EIMs) commonly occur in pediatric inflammatory bowel disease (IBD), little research has examined rates of EIMs and their relation to other disease-related factors in this population. The purpose of this study was to determine the rates of EIMs in pediatric IBD and examine correlations with age, sex, diagnosis, disease severity, and distribution.
Patients And Methods:
Data were prospectively collected as part of the Pediatric IBD Collaborative Research Group Registry, an observational database enrolling newly diagnosed IBD patients <16 years old since 2002. Rates of EIM (occurring anytime during the period of enrollment) and the aforementioned variables (at baseline) were examined. Patients with indeterminate colitis were excluded from the analysis given the relatively small number of patients.
Results:
One thousand nine patients were enrolled (mean age 11.6 +/- 3.1 years, 57.5% boys, mean follow-up 26.2 +/- 18.2 months). Two hundred eighty-five (28.2%) patients experienced 1 or more EIMs. Eighty-seven percent of EIM occurred within the first year. Increased disease severity at baseline (mild vs moderate/severe) was associated with the occurrence of any EIM (P < 0.001), arthralgia (P = 0.024), aphthous stomatitis (P = 0.001), and erythema nodosum (P = 0.009) for both Crohn disease (CD) and ulcerative colitis (UC) during the period of follow-up. Statistically significant differences in the rates of EIMs between CD and UC were seen for aphthous stomatitis, erythema nodosum, and sclerosing cholangitis.
Conclusions:
EIMs as defined in this study occur in approximately one quarter of pediatric patients with IBD. Disease type and disease severity were commonly associated with the occurrence of EIMs.
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