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Features and Outcomes of Children with Ulcerative Colitis who Undergo a Diagnostic Change: A Single-Center Experience
Natsuki Ito1,2, Ichiro Takeuchi1, Reiko Kyodo1,2
1Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan.
Insights
Approximately 10% of pediatric patients initially diagnosed with ulcerative colitis (UC) later received a Crohn's disease (CD) diagnosis. Lower albumin, anemia, and biologic use may predict this diagnostic change in pediatric inflammatory bowel disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Accuracy in Pediatrics
Background:
- Diagnostic uncertainty between ulcerative colitis (UC) and Crohn's disease (CD) is common in pediatric inflammatory bowel disease (IBD).
- Limited data exists on the clinical characteristics and predictors of diagnostic change from UC to CD in children.
- Understanding these factors is crucial for accurate diagnosis and management of pediatric IBD.
Purpose of the Study:
- To describe clinical characteristics of pediatric patients with UC who were later diagnosed with CD.
- To identify variables associated with the diagnostic change from UC to CD in pediatric IBD patients.
Main Methods:
- Retrospective review of medical records of pediatric patients initially diagnosed with UC.
- Comparison of clinical phenotype, laboratory results, endoscopic findings, and treatment between patients whose diagnosis changed to CD (cCD) and those who remained UC (rUC).
Main Results:
- Of 111 pediatric patients initially diagnosed with UC, 11 (9.9%) were later diagnosed with CD.
- No significant differences in sex, age, or disease extent/severity at initial diagnosis between cCD and rUC groups.
- Lower albumin and hemoglobin levels, and a higher requirement for biologics were observed in the cCD group compared to the rUC group.
Conclusions:
- Approximately 10% of children with an initial UC diagnosis were later reclassified as CD.
- Hypoalbuminemia, anemia at initial diagnosis, and the need for biologic therapy may serve as predictors for this diagnostic shift in pediatric IBD.
Purpose:
A change in diagnosis from ulcerative colitis (UC) to Crohn's disease (CD) has been reported in pediatric inflammatory bowel disease; however, only a few clinical characteristics and predictors of this diagnostic change have been reported. We aimed to describe the clinical characteristics of patients with UC who underwent a change in diagnosis to CD and identify variables associated with the change.
Methods:
The medical records of pediatric patients with UC who were followed up at the National Center for Child Health and Development between 2006 and 2019 were retrospectively reviewed. Clinical data on disease phenotype, laboratory parameters, endoscopic findings, and treatment of patients whose diagnosis changed to CD (cCD) were compared to those of patients whose diagnosis remained UC (rUC).
Results:
Among the 111 patients initially diagnosed with UC, 11 (9.9%) patients were subsequently diagnosed with CD during follow-up. There was no significant difference between the cCD and rUC groups in terms of sex, age at initial diagnosis, and the extent and severity of disease at initial diagnosis. Albumin and hemoglobin levels were significantly lower in the cCD group than in the rUC group. The proportion of patients who required biologics was significantly higher in the cCD group than in the rUC group (p<0.05).
Conclusion:
Approximately 10% children initially diagnosed with UC were subsequently diagnosed with CD. Hypoalbuminemia and anemia at initial diagnosis and use of biologics could be predictors of this diagnostic change.
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