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Histopathological changes in anatomical distribution of inflammatory bowel disease in children: a retrospective
Jessica Tsang1, Sheena Sikora, Donald Spady
1Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Pediatric inflammatory bowel disease (IBD) often progresses histopathologically, especially in Crohn's disease. Female sex and elevated erythrocyte sedimentation rate predict progression in pediatric Crohn's disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Histopathology
Background:
- Anatomical progression patterns in pediatric inflammatory bowel disease (IBD) are not well-documented.
- Understanding disease evolution in children is crucial for effective management.
Purpose of the Study:
- To investigate changes in the anatomical distribution of IBD in pediatric patients.
- To identify factors influencing disease progression at diagnosis and during follow-up.
Main Methods:
- Retrospective cohort study of pediatric IBD patients with at least two endoscopic examinations.
- Primary outcome: histopathological progression assessed via biopsies.
- Analysis of factors predictive of disease progression.
Main Results:
- 98 patients included; 54 with ulcerative colitis (UC), mean age 10.6 years.
- 41% of UC patients showed progression; no predictive factors identified.
- 75% of Crohn's disease (CD) patients progressed; female sex and high ESR were predictive.
Conclusions:
- Most pediatric Crohn's disease patients experience histopathological progression despite treatment.
- Female sex and elevated erythrocyte sedimentation rate are potential predictors of progression in pediatric CD.
- No predictive factors for progression were found in pediatric ulcerative colitis.
Background:
Anatomical progression of pediatric inflammatory bowel disease is under-reported. The aim of this work was to examine possible changes in the anatomical distribution of IBD in pediatric patients at diagnosis and at follow up.
Methods:
In a retrospective cohort study, the medical records of children with inflammatory bowel disease were examined. Patients who had at least 2 endoscopic/colonoscopic examinations were included. Primary outcome was histopathological progression based on histopathological examination of biopsies taken during endoscopic and colonoscopic bowel examination. Factors predictive of disease progression were also examined.
Results:
A total of 98 patients fulfilled inclusion criteria (49 female, 54 with ulcerative colitis, range 2 - 17 years, mean age at diagnosis was 10.6 years, SD ± 3.67), the mean duration of follow up was 32.9 months (range 0.1 - 60 months, SD ± 8.54). In the ulcerative colitis group, 41% had disease progression and none of the examined variables (age, gender, laboratory markers, growth and disease activity at diagnosis) appeared to effect disease progression. In the Crohn's disease group, 75% had disease progression. Girls (OR = 0.13, 95% CI 0.02 - 0.79) and patients with high erythrocytic sedimentation rate (OR=0.942, 95% CI 0.894 - 0.99) were predictive for disease progression.
Conclusions:
Despite maximum therapy, the majority of children with Crohn's disease appeared to have histopathological disease progression. Female sex and high erythrocytic sedimentation rate seemed to be predictive for disease progression. None of the factors analyzed seemed predictive of disease progression in ulcerative colitis.
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