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Phenotypic Variation in Paediatric Inflammatory Bowel Disease by Age: A Multicentre Prospective Inception Cohort
J Dhaliwal1, T D Walters1, D R Mack2
1SickKids Hospital, University of Toronto, Toronto, ON, Canada.
Insights
Paediatric inflammatory bowel disease [IBD] shows varied phenotypes across age groups in Canada. While disease location changes with age, severity and growth impairment are consistent, with earlier diagnosis improving linear growth in Crohn
Area of Science:
- Paediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Canadian paediatric inflammatory bowel disease [IBD] incidence is high, with a potential decrease in age of onset.
- Understanding phenotypic variations across the paediatric age spectrum is crucial for effective management.
Purpose of the Study:
- To examine variations in IBD phenotype across different paediatric age groups.
- To evaluate the applicability of the Paris classification for age at diagnosis.
Main Methods:
- A multicentre, nationwide inception cohort study of new-onset paediatric IBD.
- Inclusion criteria: Children aged 2 to <17 years at diagnosis.
- Systematic evaluation and prospective recording of phenotypic data, compared between age groups.
Main Results:
- 1092 children studied: 64% Crohn's disease [CD], 36% ulcerative colitis/inflammatory bowel disease unclassified [UC/IBD-U].
- Very-early-onset IBD [VEO-IBD, <6 years] and early-onset [age 6 to <10 years] showed less CD and more colon-only disease.
- Ileal disease and stricturing/penetrating CD increased with age until 10 years. UC was extensive [E3/E4] in >85% with moderate to severe activity.
- Linear growth was modestly reduced in CD but normal in UC/IBD-U.
Conclusions:
- The Paris classification is supported by age-related increases in ileal disease until age 10.
- Phenotypic features like severity are similar across paediatric age groups.
- Improved linear growth in CD compared to historical cohorts suggests benefits of earlier diagnosis.
Background And Aims:
Incidence of paediatric inflammatory bowel disease [IBD] in Canada is among the highest worldwide, and age of onset may be decreasing. In a multicentre nationwide inception cohort study, we examined variation in phenotype of IBD throughout the paediatric age spectrum.
Methods:
Children aged ≥2 years [y] and <17y [A1 age at diagnosis], with new onset IBD, were systematically evaluated at sites of the Canadian Children IBD Network. Prospectively recorded phenotypic data were compared between age groups.
Results:
Among 1092 children (70% Caucasian; 64% Crohn's disease [CD], 36% ulcerative colitis/inflammatory bowel disease unclassified [UC/IBD-U]; median age 13 y, interquartile range [IQR] 11-15 y), 210 [19%] were diagnosed before the age of age 10 y [Paris A1a] and 43 [4%] before age 6 y (very-early-onset [VEO-IBD]). CD was less common in younger children [42%, 56%, 66%, respectively, of VEO-IBD, A1a; A1b]. Colon-only IBD [UC/IBDU or CD-colon] was present in 81% of VEO-IBD and 65% of A1a; ileal disease increased progressively, reaching plateau at age 10 y. CD location was ileocolonic [L3] in 53% overall. Ileitis [L1] increased with age [6% of VEO-IBD; 13% of A1a; 21% of A1b], as did stricturing/penetrating CD [4% of A1a; 11% of A1b]. At all ages UC was extensive [E3/E4] in >85%, and disease activity moderate to severe according to Physician's Global Assessment [PGA] and weighted Paediatric Crohn's Disease Activity Index/Paediatric Ulcerative Colitis Activity Index [wPCDAI/PUCAI] in >70%. Heights were modestly reduced in CD [mean height z score -0.30 ± 1.23], but normal in UC/IBD-U.
Conclusions:
Paris classification of age at diagnosis is supported by age-related increases in ileal disease until age 10 years. Other phenotypic features, including severity, are similar across all ages. Linear growth is less impaired in CD than in historical cohorts, reflecting earlier diagnosis.
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