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Inflammatory Bowel Disease in Children with Elevated Serum Gamma Glutamyltransferase Levels
Abin Chandrakumar1, Rachael Loeppky2, Mark Deneau3
1Clinical Research Unit, Children's Hospital Research Institute of Manitoba; Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences and Children's Hospital Research Institute.
Insights
Pediatric patients with elevated gamma glutamyltransferase (GGT) levels are more prone to developing primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). Mild GGT elevations, particularly at baseline, may indicate a predisposition to PSC-UC in children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Inflammatory Bowel Disease Research
Background:
- Inflammatory bowel disease (IBD) encompasses conditions like ulcerative colitis (UC) and Crohn's disease.
- Primary sclerosing cholangitis (PSC) is a chronic liver disease often associated with IBD, particularly UC.
- Identifying risk factors for PSC-UC in pediatric populations is crucial for early intervention.
Purpose of the Study:
- To investigate the association between elevated gamma glutamyltransferase (GGT) levels and the development of PSC-UC in children diagnosed with UC.
- To characterize the clinical features and disease prognosis of pediatric UC patients who develop PSC.
Main Methods:
- A longitudinal, population-based cohort study of children and young adults diagnosed with UC in Manitoba, Canada (2011-2018).
- PSC diagnosis confirmed via cholestatic biochemical markers and cholangiography.
- Statistical analysis, including Fisher exact test with Bonferroni correction, was used to compare groups.
Main Results:
- Of 95 children with UC, 9 developed PSC-UC (incidence rate: 6.43 per 1000 person-years).
- Children with high baseline serum GGT levels had a significantly higher risk of developing PSC-UC (72.7% vs 1.2%, P < .001).
- High GGT levels were associated with pancolitis (P = .01) and perinuclear neutrophil antibodies positivity (P = .01).
Conclusions:
- Elevated serum GGT levels in pediatric UC patients, even mild elevations at baseline, may indicate a predisposition to developing PSC.
- Early monitoring of GGT levels in pediatric UC patients could aid in identifying those at higher risk for PSC-UC.
Objective:
To assess the characteristics of inflammatory bowel disease and disease prognosis among children with elevated gamma glutamyltransferase (GGT) and primary sclerosing cholangitis (PSC)-ulcerative colitis (UC).
Study Design:
Our longitudinal, population-based cohort comprised all children and young adults diagnosed with UC in the Canadian province of Manitoba between 2011 and 2018. Diagnosis of PSC was confirmed based on a combination of cholestatic biochemical markers and cholangiographic features. The Fisher exact test with Bonferroni correction was used to examine the relationship between categorical variables.
Results:
We enrolled 95 children with UC/Inflammatory bowel disease-unclassified with a median age at diagnosis of 14 years (IQR: 10.4-15.9 years) and 1399 person-years follow-up. Among them, 9 children developed PSC-UC, with an incidence rate of 6.43 new cases per 1000 person-years. In this cohort, 8 (72.7%) of 11 children with high baseline serum GGT levels developed PSC-UC in comparison with 1 (1.2%) of 84 children with normal serum GGT levels at baseline (P < .001). All children with high serum GGT levels at diagnosis had pancolitis in comparison with 63.9% of children with normal serum GGT levels (P = .01). Children with high serum GGT levels were more likely to be perinuclear neutrophil antibodies-positive than those with normal levels (90.9% vs 52.0%, P = .01).
Conclusions:
Our findings indicated that pediatric patients with UC and with even mild elevations of serum GGT levels, especially at baseline, might be predisposed to develop PSC.
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