Evaluation of Risk for Thromboembolic Events in Pediatric Inflammatory Bowel Disease
Anna Dilillo1, Emanuela Del Giudice1, Salvatore Cucchiara2
1Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina.
Insights
Children with inflammatory bowel disease (IBD) exhibit thromboembolic risk factors similar to adults. This study identified clinical and laboratory factors contributing to this increased risk in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Clinical Medicine
Background:
- Thrombotic events are common in adult inflammatory bowel disease (IBD) patients due to hereditary and acquired risk factors.
- Limited data exist on thromboembolic risk factors in pediatric IBD populations.
- This study addresses the gap in knowledge regarding thrombotic risk in children with IBD.
Purpose of the Study:
- To investigate the presence and nature of thromboembolic risk factors in children diagnosed with IBD.
- To compare these risk factors between pediatric patients with Crohn disease (CD) and ulcerative colitis (UC) and healthy controls.
- To explore the relationship between disease activity and thromboembolic risk markers in pediatric IBD.
Main Methods:
- Three groups of children were enrolled: CD, UC, and healthy controls.
- Clinical evaluation and laboratory tests were performed to assess thromboembolic risk.
- Disease activity was measured using the Pediatric Crohn Disease Activity Index and Pediatric Ulcerative Colitis Activity Index.
Main Results:
- Serum fibrinogen levels were significantly higher in moderate/severe UC patients compared to mild UC patients.
- Serum homocysteine levels were lower in healthy controls than in CD and UC patients.
- An elevated homocysteine level was observed in UC patients with a specific MTHFR gene mutation.
Conclusions:
- Children with IBD present with clinical, acquired, and congenital factors that elevate thrombotic risk, mirroring adult findings.
- Specific laboratory markers like fibrinogen and homocysteine indicate heightened thrombotic risk in pediatric IBD.
- Further research is warranted to elucidate the precise mechanisms and management strategies for thromboembolism in pediatric IBD.
Objectives:
The occurrence of thrombotic events in adult patients with inflammatory bowel disease (IBD) is linked to multiple interactions between hereditary and acquired risk factors. There are few published data concerning children with iBD. The aim of this study was to investigate the presence of thromboembolic risk factors also in children with iBD.
Methods:
We enrolled three groups of children: one with Crohn disease (cD), one with ulcerative colitis (Uc), and a control group of healthy subjects. For all the participants the potential thromboembolic risk was evaluated clinically and with laboratory tests.
Results:
We studied: 30 children (25.6%) with CD, 28 (23.9%) with UC, and 59 (50.4%) healthy control subjects. Regarding Pediatric Crohn Disease Activity Index, no significant differences between thromboembolic risk factors and disease activity were detected. Instead, in the patients with UC, stratified with the Pediatric Ulcerative Colitis Activity Index, there was a statistically significant difference in serum fibrinogen levels between patients with mild and moderate/severe disease [3.8 (3.2-4.5) g/L vs 5.7 (4.8-6.2) g/L, P < 0.0032]. serum homocysteine levels were lower in healthy controls than in CD (P = 0.176) and UC (P = 0.026). An increased level ofhomocysteine in UC with a homozygous mutation in the methylene tetrahydrofolate reductase C677T gene was also observed.
Conclusions:
Our study showed that children with IBD have clinical features, acquired and congenital factors that can increase thrombotic risk, similarly to adults.
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