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Published on: September 22, 2019
Clinical patterns and outcome of early-onset inflammatory bowel disease
Oren Ledder1, Anthony G Catto-Smith, Mark R Oliver
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Extremely-early-onset inflammatory bowel disease (IBD) in children under six presents differently than in older children. Early-onset IBD, particularly ulcerative colitis, shows a more aggressive clinical course requiring more intensive treatments and surgery.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Pediatrics
Background:
- Inflammatory Bowel Disease (IBD) encompasses chronic conditions like ulcerative colitis (UC) and Crohn's disease (CD).
- The clinical presentation and severity of IBD can vary significantly based on age of onset.
- Understanding early-onset IBD is crucial for timely and appropriate management.
Purpose of the Study:
- To compare the clinical severity of extremely-early-onset IBD (age <6 years) with that of older children (6-17 years).
- To identify distinct phenotypic differences between early-onset and later-onset pediatric IBD cases.
Main Methods:
- A retrospective sequential diagnosis study comparing two pediatric cohorts.
- Cohort 1: Extremely-early-onset IBD (age <6 years) including 20 UC, 8 CD, 2 indeterminate cases.
- Cohort 2: Older children (6-17 years) including 19 UC, 39 CD, 2 indeterminate cases.
Main Results:
- Early-onset ulcerative colitis (UC) showed less initial abdominal pain but a more aggressive disease course.
- Children with early-onset UC experienced significant weight-for-age reduction, increased immunosuppressant use, and higher rates of surgery.
- Early-onset Crohn's disease (CD) was associated with a higher likelihood of bloody stools and isolated colitis at presentation.
Conclusions:
- The phenotype of pediatric inflammatory bowel disease differs significantly based on age of onset.
- Extremely-early-onset IBD, especially UC, demonstrates a more severe clinical trajectory requiring aggressive management strategies.
- These findings underscore the importance of age-specific diagnostic and treatment approaches for pediatric IBD.
Abstract:
We sought to determine whether extremely-early-onset childhood inflammatory bowel disease (age <6 years; 20 ulcerative colitis [UC], 8 Crohn disease [CD], 2 indeterminate, sequentially diagnosed) was clinically more severe than in older children (6-17 years; 19 UC, 39 CD, 2 indeterminate). Early-onset UC was marked by less abdominal pain at presentation, but an aggressive course with a significant reduction in weight-for-age, increased use of immunosuppressants, and more surgery. Children with early-onset CD were more likely to have bloody stools at presentation and an isolated colitis. This study supports the suggestion that inflammatory bowel disease phenotype differs in early-onset disease.
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