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Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease--a population-based
C Jakobsen1, J Bartek, V Wewer
1Department of Paediatrics, Hvidovre University Hospital, Copenhagen, Denmark. christian.jakobsen@hvh.regionh.dk
Insights
Pediatric ulcerative colitis patients experienced more extensive disease and a more severe course than adults. Crohn's disease showed no significant differences between pediatric and adult patients in this inflammatory bowel disease study.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Comparative Clinical Studies
Background:
- Limited research exists on comparing inflammatory bowel disease (IBD) phenotypes and disease progression in pediatric versus adult populations.
- Understanding these differences is crucial for tailored treatment strategies.
Purpose of the Study:
- To conduct a comparative analysis of phenotype, treatment, and disease course in pediatric (under 15 years) and adult (18 years and older) IBD patients.
- To identify age-specific variations in ulcerative colitis and Crohn's disease management and outcomes.
Main Methods:
- Utilized two population-based cohorts from Copenhagen County and City, including pediatric (2001-2006) and adult (2003-2004) IBD patients.
- Followed patients for a median of 4.8 years (pediatric) and 5.2 years (adults) to assess disease parameters.
Main Results:
- Pediatric ulcerative colitis (UC) patients presented with more extensive disease (70% vs. 19%, P<0.001) and higher rates of systemic steroid (HR: 3.1) and azathioprine/mercaptopurine (HR: 2.5) initiation compared to adults.
- Steroid dependency was significantly more frequent in pediatric UC patients (45% vs. 8%, P<0.001), with a less frequent mild disease course (35% vs. 72%, P=0.002).
- No significant differences in treatment or disease course were observed between pediatric and adult Crohn's disease (CD) patients. Five-year surgery rates were comparable across age groups for both UC and CD.
Conclusions:
- Pediatric UC patients exhibit a more severe disease phenotype, requiring more aggressive treatment and experiencing greater steroid dependency than adult UC patients.
- In contrast, pediatric and adult Crohn's disease patients demonstrate similar treatment approaches and disease progression.
- Findings highlight the need for age-specific management considerations for ulcerative colitis.
Background:
Few studies have compared phenotype and disease course in children and adults with inflammatory bowel disease (IBD).
Aim:
To compare phenotype, treatment and disease course in children (<15 years) and adults (≥18 years) with IBD.
Methods:
Two population-based cohorts comprising paediatric (2001-2006) and adult (2003-2004) patients from Copenhagen County and City were studied.
Results:
Twenty children and 106 adults with ulcerative colitis (UC), and 29 children and 67 adults with Crohn's disease (CD) were included. Median follow-up time was 4.8 years (children) and 5.2 years (adults). Children with UC had more extensive disease compared to adult patients [14 (70%) vs. 20 (19%), P<0.001]. The risks of starting systemic steroid treatment and AZA/MP were higher for paediatric UC patients compared to adult UC patients; hazard ratio (HR): 3.1 (95% CI: 1.8-5.3) and HR: 2.5 (1.3-5-9), respectively. Steroid dependency was more frequent in paediatric than in adult UC patients [9 (45%) vs. 9 (8%), P<0.001]. Mild disease course was less frequent in children with UC compared to adult patients [7 (35%) vs. 76 (72%), P=0.002]. Paediatric and adult CD patients did not differ regarding treatment or disease course. Cumulative 5-year surgery rates for paediatric and adult patients were 5% and 9% for UC (N.S.) and 18% and 21% for CD (N.S.), respectively.
Conclusions:
Paediatric UC patients had more extensive disease, were more often treated with systemic steroids and AZA, had a higher frequency of steroid dependency and a more severe disease course compared to adult UC patients. No differences were found when comparing paediatric and adult CD patients.
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