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Ocular Manifestations of Paediatric Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Giorgio Ottaviano1, Silvia Salvatore1, Alessandro Salvatoni1
1Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy.
Insights
Ocular manifestations in pediatric inflammatory bowel disease are uncommon but may be underestimated. Children with Crohn's disease have a higher risk of these eye complications.
Area of Science:
- Ophthalmology
- Pediatrics
- Gastroenterology
Background:
- Ocular extraintestinal manifestations (O-EIMs) are known complications of pediatric inflammatory bowel disease (IBD), including Crohn's disease (CD), ulcerative colitis (UC), and IBD unclassified (IBD-U).
- Limited data exist on the prevalence of O-EIMs in children, and there are no clear follow-up recommendations.
- This study addresses the scarcity of information regarding O-EIMs in pediatric IBD populations.
Purpose of the Study:
- To review available data on the prevalence of O-EIMs in children with IBD.
- To assess the risk of O-EIMs in different types of pediatric IBD.
- To evaluate the findings of ophthalmological screening in asymptomatic children with IBD.
Main Methods:
- Systematic review of English literature published up to January 2018.
- Searches conducted using PubMed and EMBASE databases with disease-specific queries.
- Inclusion of fifteen studies reporting on O-EIMs prevalence in 7467 pediatric patients.
Main Results:
- Overall O-EIM prevalence in children ranged from 0.62% to 1.82%, with uveitis being the most common.
- Children with CD showed a significantly increased risk of O-EIMs compared to those with UC and IBD-U (OR 2.70).
- Mild, asymptomatic uveitis was detected in 1.06-23.1% of screened asymptomatic children, particularly males with CD and colonic involvement.
Conclusions:
- Data on pediatric O-EIMs are limited, and prevalence may be underestimated due to asymptomatic cases.
- Children with CD appear to be at higher risk for O-EIMs.
- While routine screening isn't recommended, a low threshold for ophthalmological referral is advised for pediatric IBD patients.
Background And Aims:
Ocular extraintestinal manifestations [O-EIMs] are known complications of Crohn's disease [CD], ulcerative colitis [UC], and inflammatory bowel disease unclassified [IBD-U]. However, data on their prevalence in children are scarce and there are no clear recommendations on what follow-up should be offered. We aimed to review available data on O-EIMs in children.
Methods:
In January 2018, we performed a systematic review of published English literature using PubMed and EMBASE databases and disease-specific queries.
Results:
Fifteen studies [7467 patients] reported data on O-EIMs prevalence in children. Overall prevalence of O-EIMs was 0.62-1.82%. Uveitis was the most common O-EIM. Meta-analysis showed that children with CD are at increased risk of O-EIMs as compared with children with UC and IBD-U (odds ratio [OR] 2.70, 95% confidence interval [CI] 1.51-4.83). Five studies [357 patients] reported data on ophthalmological screening in asymptomatic children: mild asymptomatic uveitis was identified in a variable proportion of patients [1.06-23.1%], more frequently in male patients with CD and colonic involvement. No evidence of ocular complications from untreated uveitis was detected. A total of 23 case reports [24 patients] were identified.
Conclusions:
Data on O-EIMs in children are scarce. Prevalence of O-EIMs is lower than in adults but may be underestimated because of the possibility of asymptomatic uveitis; however, the long-term significance of this condition is unknown. Children with CD may be at increased risk of O-EIMs. No recommendations on routine ophthalmological examination can be made, but a low threshold for ophthalmological referral should be maintained. Larger studies in paediatric IBD populations are needed.
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