Adherence to the Porto Criteria Based on the Hungarian Nationwide Pediatric Inflammatory Bowel Disease Registry
Katalin E Müller1,2, Antal Dezsőfi3, Áron Cseh3
1Heim Pál National Pediatric Institute, Budapest, Hungary.
Insights
Adherence to pediatric inflammatory bowel disease (pIBD) diagnostic criteria improved significantly over a decade. Magnetic resonance enterography (MRE) showed a 39% diagnostic yield in specific pediatric cases.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Imaging in Pediatrics
Background:
- The Porto criteria recommend upper endoscopy, ileocolonoscopy with histology, and small bowel imaging (SBI) for pediatric inflammatory bowel disease (pIBD) diagnosis.
- Adherence to these comprehensive diagnostic guidelines in pediatric populations has been variable.
- Evaluating diagnostic practices and the utility of advanced imaging like MRE is crucial for improving pIBD management.
Purpose of the Study:
- To assess adherence to the Porto criteria in a nationwide pediatric IBD inception cohort.
- To examine trends in biopsy sampling practices over a 10-year period.
- To determine the diagnostic yield of magnetic resonance enterography (MRE) as an initial diagnostic tool in select pIBD patients.
Main Methods:
- Analysis of diagnostic workup data from the Hungarian Paediatric IBD Registry (HUPIR) for newly diagnosed pIBD cases (ages 0-18) between 2007 and 2016.
- Evaluation of adherence rates to the Porto criteria and biopsy sampling frequency.
- Assessment of MRE's diagnostic yield in patients lacking characteristic Crohn's disease lesions.
Main Results:
- Forty percent of 1,523 analyzed cases met the Porto criteria, with adherence increasing from 20% to 57% (p < 0.0001) over the study period.
- Lack of small bowel imaging was the primary reason for incomplete workup (59%).
- Biopsy sampling from all segments increased from 8% to 51% (p < 0.0001), while MRE yielded positive findings in 39% of 113 evaluated patients.
Conclusions:
- Significant improvement in adherence to the Porto criteria was observed over the decade.
- Comprehensive biopsy sampling remains a less adopted recommendation within the Porto criteria.
- MRE demonstrates a notable diagnostic yield (39%) in pediatric patients without overt Crohn's disease indicators on initial assessment.
Abstract:
Objectives: According to the Porto criteria, upper endoscopy and ileocolonoscopy with histology for patients with pediatric inflammatory bowel disease (pIBD) are recommended with small bowel imaging (SBI). We aimed to evaluate the adherence to the Porto criteria and biopsy sampling practice and to evaluate the diagnostic yield of magnetic resonance enterography (MRE) first time in a nationwide pIBD inception cohort. Methods: Newly diagnosed pIBD cases (ages 0-18 years) are registered in the prospective, nationwide Hungarian Paediatric IBD Registry (HUPIR). We analyzed the diagnostic workup of patients recorded between the 1st of January 2007 and the 31st of December 2016. Results: Data for diagnostic workup was available in 1,523 cases. Forty percent of the cases had complied with the Porto criteria. Adherence to the Porto criteria increased significantly from 20 to 57% (p < 0.0001) between 2007 and 2016. The most frequent reason for the incomplete diagnostic work-up was the lack of small bowel imaging (59%). In 2007, 8% of cases had a biopsy from all segments, and this rate reached 51% by 2016 (p < 0.0001). We analyzed the diagnostic yield of MRE in 113 patients (10.1%), who did not have any characteristic lesion for Crohn's disease. The MRE was positive for the small bowel in 44 cases (39%). Conclusions: Adherence to the Porto criteria increased significantly during the 10-year period. This is the first study that reports multiple biopsy sampling as the less accepted recommendation. The diagnostic yield of MRE in patients without characteristic lesion for Crohn's disease is 39%.
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