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Published on: September 22, 2019
Inflammatory bowel disease developing in paediatric and adult age
Graziella Guariso1, Marco Gasparetto, Laura Visonà Dalla Pozza
1Unit of Gastroenterology, Department of Paediatrics, University of Padua, Italy. guariso@pediatria.unipd.it
Insights
Pediatric inflammatory bowel disease (IBD) often presents with perianal and extraintestinal manifestations, unlike adult-onset IBD which is more commonly associated with severe abdominal pain, diarrhea, and anorexia. These differences highlight distinct disease phenotypes in childhood-onset IBD.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Clinical Medicine
Background:
- Inflammatory bowel disease (IBD) incidence is rising globally.
- Phenotypic differences between pediatric and adult-onset IBD are not well-established.
- Understanding these differences is crucial for tailored treatment strategies.
Purpose of the Study:
- To compare the clinical and phenotypic expression of IBD in pediatric-onset versus adult-onset patients.
- To identify distinct disease characteristics based on age at onset.
- To analyze IBD manifestations within a single tertiary referral center.
Main Methods:
- Retrospective and prospective data analysis of 312 IBD patients diagnosed between 1994-2008.
- Comparison of disease manifestations between pediatric-onset (n=133) and adult-onset (n=179) IBD cohorts.
- Paediatric patients were sub-categorized into age groups: 0-5, 6-12, and 13-17 years.
Main Results:
- Pediatric-onset IBD showed higher rates of perianal disease (12.8%) and extraintestinal manifestations (14.3%) at onset.
- Adult-onset IBD patients more frequently presented with severe abdominal pain, diarrhea, and anorexia.
- During follow-up, extraintestinal manifestations and perianal disease were more common in the pediatric group.
Conclusions:
- The phenotypic expression of IBD in pediatric-onset patients differs significantly from adult-onset cases.
- Distinct clinical features at onset and during follow-up suggest different disease trajectories.
- These findings underscore the importance of age-specific considerations in IBD management.
Background And Objective:
In recent decades, there has been a significant increase in the incidence of inflammatory bowel disease (IBD). It has yet to be established whether the manifestations of IBD are similar in paediatric and adult ages. The objective of this study was to compare the phenotypic expression of the disease between patients with childhood-onset IBD and adulthood-onset cases, all afferent to the same clinical centre.
Patients And Methods:
Descriptive and multivariate analyses were completed on retrospective and prospective data of paediatric-onset and adult-onset consecutive cases who were diagnosed and followed at the same tertiary referral hospital of the University of Padua, Italy, during a period of 14 years (1994-2008). Paediatric-onset patients were further divided into age brackets (0-5, 6-12, and 13-17 year-olds). Analyses were conducted using the SAS package, version 9.1 (SAS Institute Inc, Cary, NC).
Results:
Three hundred twelve patients were analysed. At disease onset, the manifestations which were more frequent among the 133 paediatric patients (50.4% with diagnosis of Crohn disease [CD], 43.6% with ulcerative colitis, and 6% with unclassified IBD) with respect to the adult-onset patients were perianal disease (12.8%) (P < 0.0001) and extraintestinal manifestations (14.3%) (P = 0.043). Among the 179 adult patients (55.3% with diagnosis of ulcerative colitis, 36.3% with CD, and 8.3% with unclassified IBD) instead, severe abdominal pain (P = 0.008), diarrhoea (P = 0.005), and anorexia (P < 0.0001) were more frequently observed. During the follow-up, the presence of extraintestinal manifestations (50.4%) (P = 0.005) and perianal disease (44.8% of the patients with childhood-onset CD) (P = 0.006) was observed more often in the paediatric-onset group.
Conclusions:
In our cases, the phenotypic expression of IBD developing in paediatric age differs from that seen in adults.
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