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Phenotype and disease course of early-onset pediatric inflammatory bowel disease
Marina Aloi1, Paolo Lionetti, Arrigo Barabino
11Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy; 2Gastroenterology and Nutrition Unit, Meyer Pediatric Hospital, Florence, Italy; 3Gastroenterology and Endoscopy Unit, G. Gaslini Institute for Children, Genoa, Italy; 4Department of Pediatric Gastroenterology, University of Padua, Padua, Italy; 5Pediatric Gastroenterology, University of Messina, Messina, Italy; 6Pediatric Department, Buzzi Children's Hospital of Milan, Milan, Italy; 7Pediatric Gastroenterology and Endoscopy, University of Messina, Messina, Italy; 8Pediatric Gastroenterology and Endoscopy Unit, Spirito Santo Hospital, Pescara, Italy; 9Department of Pediatrics, University of Naples Federico II, Naples, Italy; 10Pediatric Department, Maggiore Hospital, Bologna, Italy; 11Pediatric Department, Giovanni XXIII Hospital, Bari, Italy; 12Pediatric Gastroenterology Unit, University of Turin, Turin, Italy; 13Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; and 14Department of Pediatrics, Institute of Child Health, IRCSS Burlo Garofalo, Trieste, Italy.
Insights
Early-onset pediatric inflammatory bowel diseases (IBD) present with more extensive disease and may require aggressive treatment. However, surgical risks are similar to later-onset IBD, and family history is uncommon in early-onset cases.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Phenotyping
Background:
- Early-onset pediatric inflammatory bowel diseases (IBD) may exhibit more extensive disease patterns compared to later-onset cases.
- Understanding the phenotypic differences and disease course in early-onset IBD is crucial for effective management.
Purpose of the Study:
- To investigate the hypothesis that early-onset pediatric inflammatory bowel diseases (IBD) are more extensive than those with later onset.
- To compare the phenotype and disease course of IBD patients diagnosed between 0-5 years with those diagnosed at 6-11 and 12-18 years.
Main Methods:
- Phenotypic analysis of 506 pediatric IBD patients using the Paris classification for anatomic locations and behaviors.
- Categorization of patients into three age-at-diagnosis groups: 0-5 years, 6-11 years, and 12-18 years.
- Comparison of disease characteristics, family history, and treatment strategies across the age groups.
Main Results:
- Early-onset IBD (0-5 years) showed a higher prevalence of unclassified IBD and more frequent isolated colonic and upper gastrointestinal involvement in Crohn's disease.
- Pancolonic ulcerative colitis was significantly more common in the 0-5 years group (62%) compared to older groups.
- While initial therapies were similar, a higher proportion of younger children with early-onset IBD required steroids at follow-up.
Conclusions:
- Early-onset IBD presents with a more extensive phenotype and warrants aggressive treatment strategies.
- Despite extensive disease, surgical risk in early-onset IBD is comparable to later-onset disease.
- Family history is not a significant factor in early-onset IBD cases.
Background:
Early-onset (EO) pediatric inflammatory bowel diseases (IBD) seem to be more extensive than those with a later onset. To test this hypothesis, we examined the phenotype and disease course of patients with IBD diagnosis at 0 to 5 years, compared with the ranges 6 to 11 and 12 to 18 years.
Methods:
Anatomic locations and behaviors were assessed according to Paris classification in 506 consecutive patients: 224 Crohn's disease, 245 ulcerative colitis, and 37 IBD-unclassified.
Results:
Eleven percent of patients were in the range 0 to 5 years, 39% in 6 to 11 years, and 50% in 12 to 18 years. Ulcerative colitis was the most frequent diagnosis in EO-IBD and in 6- to 11-year-old group, whereas Crohn's disease was predominant in older children. A classification as IBD-unclassified was more common in the range 0 to 5 years compared with the other groups (P < 0.005). EO Crohn's disease showed a more frequent isolated colonic (P < 0.005) and upper gastrointestinal involvement than later-onset disease. Sixty-two percent of the patients in the 0 to 5 years range had pancolonic ulcerative colitis, compared with 38% of 6 to 11 years (P = 0.02) and 31% of 12-18 years (P = 0.002) range. No statistical difference for family history for IBD was found in the 3-year age groups. Therapies at the diagnosis were similar for all children. However, at latest follow-up, a significantly higher proportion of younger children were under steroids compared with older groups (P < 0.05). Surgical risk did not differ according to age.
Conclusions:
EO-IBD exhibits an extensive phenotype and benefit from aggressive treatment strategies, although surgical risk is similar to later-onset disease. A family history for IBD is not common in EO disease.
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