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Long-term Outcome of Inflammatory Bowel Disease-Unclassified in Children
Siba Prosad Paul1, Bhupinder Kaur Sandhu
1Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK. Correspondence to: Dr Siba Prosad Paul, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK. siba@doctors.org.uk.
Insights
Inflammatory bowel disease-unclassified (IBD-U) affects 7.5% of pediatric IBD cases. Many children diagnosed with IBD-U later develop Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Diagnostics
Background:
- Inflammatory bowel disease (IBD) encompasses Crohn's disease and ulcerative colitis.
- A subset of pediatric IBD patients are initially diagnosed with IBD-unclassified (IBD-U).
- Understanding the natural history of IBD-U is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the incidence of IBD-unclassified in children at diagnosis.
- To track the diagnostic evolution of pediatric IBD-U over time.
- To identify factors influencing the reclassification of IBD-U.
Main Methods:
- Retrospective analysis of pediatric patient records from 2004-2011.
- Inclusion criteria: diagnosis of IBD-U following upper gastrointestinal endoscopy, ileocolonoscopy, and small bowel imaging.
- Follow-up data collected until 2016 to record diagnostic reclassifications.
Main Results:
- Out of 344 children with IBD, 7.5% (n=26) were initially diagnosed with IBD-U.
- The majority of IBD-U patients (25/26) were followed for 4.5-11.5 years.
- Endoscopic re-evaluation led to a change in diagnosis for 10 patients (7 to Crohn's disease, 3 to ulcerative colitis).
Conclusions:
- IBD-unclassified represents a significant proportion of initial pediatric IBD diagnoses.
- A substantial percentage of children with IBD-U undergo diagnostic reclassification over time.
- Long-term follow-up and re-evaluation are essential for accurate IBD diagnosis in children.
Objective:
To document the frequency at diagnosis and evolution over time of inflammatory bowel disease-unclassified in children.
Methods:
Analysis of case records (2004-2011) of patients diagnosed with inflammatory bowel disease-unclassified following upper-gastrointestinal endoscopy, ileocolonoscopy and small bowel imaging. Any subsequent diagnostic reclassification by 2016 was recorded.
Results:
344 children diagnosed as inflammatory bowel disease: 58% Crohn's disease, 34.5% ulcerative colitis, and 7.5% (n=26) inflammatory bowel disease-unclassified. 25/26 inflammatory bowel disease-unclassified patients were followed for 4.5-11.5 years. 17 of these patients needed endoscopic re-evaluation leading to changed diagnosis in ten (Crohn's disease 7, ulcerative colitis 3).
Conclusion:
7.5% (25/344) of inflammatory bowel disease children had inflammatory bowel disease-unclassified at diagnosis; 10 (40%) evolved into Crohn's disease or ulcerative colitis.
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