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Extraintestinal Manifestations Are Associated With Disease Severity in Pediatric Onset Inflammatory Bowel Disease
Sabine Jansson1, Mikkel Malham1, Anders Paerregaard1
1Department of Pediatrics.
Insights
Children with inflammatory bowel disease (IBD) experiencing extraintestinal manifestations (EIM) show a more severe disease course. Early consideration of EIM is crucial for tailoring aggressive treatment strategies in pediatric IBD patients.
Area of Science:
- Pediatric gastroenterology
- Inflammatory Bowel Disease (IBD) research
- Extraintestinal Manifestations (EIM) studies
Background:
- Pediatric onset inflammatory bowel disease (pIBD) encompasses Crohn's disease and ulcerative colitis diagnosed in individuals under 15.
- Extraintestinal manifestations (EIM) are common in IBD but their impact on disease severity in pIBD requires further investigation.
Purpose of the Study:
- To investigate the association between extraintestinal manifestations (EIM) and disease severity in pediatric onset inflammatory bowel disease (pIBD).
- To compare the disease course of pIBD patients with and without EIM.
Main Methods:
- A population-based cohort study in Denmark included pIBD patients diagnosed between 1998-2008, followed until 2014.
- Data collected included phenotype, treatment, relapses, and temporal relationship between IBD and EIM activity via patient chart review.
Main Results:
- Among 333 pIBD patients, 14.1% developed EIM during follow-up (median 9.6 years).
- In ulcerative colitis, EIM correlated with increased need for biological treatment (HR 2.6) and surgery (HR 2.9).
- In Crohn disease, EIM were linked to higher relapse rates (IRR 1.3) and a temporal association with IBD relapse was observed.
Conclusions:
- Extraintestinal manifestations (EIM) are associated with a more severe disease course in pediatric onset inflammatory bowel disease (pIBD).
- Treatment decisions for pIBD patients should consider the presence of EIM, potentially warranting a more aggressive approach.
- Further prospective studies are recommended to fully elucidate the impact of EIM in pIBD.
Objectives:
The aim of this study was to investigate a possible association between extraintestinal manifestations (EIM) and a more severe disease course in pediatric onset inflammatory bowel disease (pIBD).
Methods:
This study compares the disease course of pIBD patients (IBD diagnosis <15 years of age) with and without EIM in a population-based cohort from Denmark. Patients diagnosed with pIBD between 1998 and 2008 were included in the study and followed until December 31, 2014. Data on phenotype, treatment, relapses, and the temporal relationship between IBD relapses and activity of EIM were collected at end of follow-up by manual revision of patient charts.
Results:
Of 333 pIBD patients, 14 (4.2%) had EIM at time of diagnosis and 47 (14.1%) developed EIM during follow-up. Median follow-up time was 9.6 years for patients with EIM and 8.8 years for patients without. In ulcerative colitis, EIM were associated with an increased risk of biological treatment and surgery (hazard ratio: 2.6; 95% confidence interval [CI]: 1.3-5.5, P = 0.008 and 2.9 [95% CI: 1.1-7.7, P = 0.03], respectively). In Crohn disease, EIM were associated with an increased relapse rate (1.3 [95% CI: 1.1-1.5], P = 0.001). Lastly, we found a positive temporal relationship between relapse of IBD and EIM activity.
Conclusion:
The presence of EIM is associated with a more severe disease course in pIBD. This should be considered when deciding treatment options, as a more aggressive treatment approach could be warranted in patients with EIM. However, prospective studies are needed to fully evaluate this.
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