Occurrence of Thromboembolism in Paediatric Patients With Inflammatory Bowel Disease: Data From the CEDATA-GPGE
Jan De Laffolie1, Antje Ballauff2, Stefan Wirth3
1Department of General Pediatrics and Neonatology, University of Giessen, Giessen, Germany.
Insights
Children with inflammatory bowel disease (IBD) face an increased risk of thromboembolism (TE). Early identification of risk factors and preventive measures are crucial for managing TE in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Thromboembolism Research
- Inflammatory Bowel Disease Studies
Background:
- Inflammatory bowel disease (IBD) is associated with an elevated risk of thromboembolism (TE), a significant cause of morbidity and mortality.
- TE in pediatric IBD patients is underrecognized compared to other extraintestinal manifestations, with an estimated incidence of 0.4-0.9% in hospitalized children.
- Understanding TE prevalence and risk factors in pediatric IBD is critical for improving patient outcomes.
Purpose of the Study:
- To analyze the incidence and characteristics of thromboembolism (TE) in pediatric patients with inflammatory bowel disease (IBD).
- To identify risk factors associated with TE in children diagnosed with IBD.
- To evaluate the outcomes and sequelae of TE in this patient population.
Main Methods:
- Retrospective analysis of pediatric IBD cases from the German-Austrian Pediatric IBD Registry (CEDATA-GPGE).
- Inclusion of 4,153 pediatric IBD patients (0-18 years) over a 10-year period.
- Data collection via questionnaires completed by treating pediatric gastroenterologists for patients with diagnosed TE.
Main Results:
- Twelve pediatric IBD patients (0.3% prevalence) were identified with TE.
- Ulcerative colitis (UC) patients had a significantly higher risk of TE compared to Crohn's disease (CD) patients (OR 5.9, p=0.008).
- TE predominantly occurred during active disease (90%), with cerebral and limb involvement in 6/12 patients; 11 of 12 patients recovered fully, one with focal epilepsy.
Conclusions:
- Pediatric patients with IBD exhibit a substantially increased risk for TE.
- Identified risk factors necessitate consideration in managing pediatric IBD, with routine preventive measures for hospitalized patients.
- Pharmacological thromboprophylaxis should be carefully considered in individual cases due to a lack of pediatric-specific trial data.
Objective:
Among patients with inflammatory bowel disease (IBD), the risk of thromboembolism (TE) is increased, representing a relevant cause of morbidity and mortality. In contrast to other extraintestinal IBD manifestations, TE receives much less attention because of its low incidence, estimated at merely 0.4-0.9% in hospitalised children with IBD.
Methods:
Cases with TE, as documented in the German-Austrian Paediatric IBD registry gesellschaft für pädiatrische gastroenterologie und ernährung - large paediatric patient registry (CEDATA-GPGE), were analyzed retrospectively. For all patients with signs of TE, a questionnaire was filled in by the treating paediatric gastroenterologist.
Results:
Over 10 years, 4,153 paediatric patients with IBD (0-18 years) were registered in the registry, and 12 of them identified with TE. Eight patients were diagnosed with ulcerative colitis (UC), three with Crohn's disease (CD), and one with IBD-unclassified. The median age at IBD diagnosis was 10 years and at the manifestation of TE 13 years, respectively, with a median latency to TE of 2 years. Prevalence of TE was 0.3%, with a significantly higher risk for patients with UC than CD (OR 5.9, CI 1.56-22.33, p = 0.008). More girls than boys were affected (f:m = 7:5) without reaching significance. Approximately 90% of patients experienced TE during active disease, with relevant cerebral and limb involvement in 6/12 patients. Various risk factors, e.g., hospitalisation, coagulopathy, or anaemia were identified. TE management included intensive care and surgery. Among the 12 patients, 11 recovered fully, in which one patient has focal epilepsy as a sequela.
Conclusion:
Paediatric patients with IBD have a substantially increased risk for TE. Risk factors, such as those identified should be considered when managing paediatric IBD and preventive measures for those hospitalised taken routinely. Initiating pharmacological thromboprophylaxis is challenging for the lack of published trials on efficacy and safety in paediatric IBD but should be considered carefully in each case.
Related Concept Videos
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...