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Factors Associated With Chronic Intestinal Inflammation Resembling Inflammatory Bowel Disease in Pediatric Intestinal
Katherine Culbreath1,2, Gregory Keefe1,2, Emily Nes1,2
1From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Insights
Parenteral nutrition dependence and intestinal dysbiosis are linked to chronic intestinal inflammation in pediatric intestinal failure patients. Inflammation severity impacts treatment escalation decisions.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Failure Research
- Inflammatory Bowel Disease Mimicry
Background:
- A subset of intestinal failure patients exhibits chronic intestinal inflammation similar to inflammatory bowel disease.
- Understanding factors contributing to this inflammation is crucial for effective management.
Purpose of the Study:
- To evaluate clinical factors associated with chronic intestinal inflammation in pediatric intestinal failure.
- To identify predictors for escalation of anti-inflammatory therapy in this population.
Main Methods:
- Retrospective case-control study of pediatric intestinal failure patients (<18 years).
- Cases defined by chronic intestinal inflammation on biopsies; exclusions applied.
- Matched case-control analysis using logistic regression; subgroup analysis for therapy escalation.
Main Results:
- Univariate analysis showed longer parenteral nutrition (PN) duration and bacterial overgrowth associated with inflammation.
- Multivariable analysis did not yield statistically significant factors.
- Subgroup analysis revealed inflammation duration, location, and severity linked to therapy escalation.
Conclusions:
- Parenteral nutrition dependence and intestinal dysbiosis are associated with chronic intestinal inflammation in pediatric intestinal failure.
- Inflammation severity correlates with the need for escalated anti-inflammatory treatment.
- Further research is required to confirm associations and treatment efficacy.
Background And Aims:
There is a subset of intestinal failure patients with associated chronic intestinal inflammation resembling inflammatory bowel disease. This study aimed to evaluate factors associated with chronic intestinal inflammation in pediatric intestinal failure.
Methods:
This was a single-center retrospective case-control study of children <18 years old with intestinal failure. Cases were defined by abnormal amounts of chronic intestinal inflammation on biopsies. Children with diversion colitis, eosinophilic colitis, or isolated anastomotic ulceration were excluded. Cases were matched 1:2 to intestinal failure controls based on sex, etiology of intestinal failure, and duration of intestinal failure. Multivariable conditional logistic regression was used to compare clinical factors between cases and controls, accounting for clustering within matched sets. A subgroup analysis was performed assessing factors associated with escalation of anti-inflammatory therapy.
Results:
Thirty cases were identified and matched to 60 controls. On univariate analysis, longer parenteral nutrition (PN) duration (1677 vs 834 days, P = 0.03), current PN use (33.3% vs 20.0%, P = 0.037), and culture-proven bacterial overgrowth (53.3% vs 31.7%, P = 0.05) were associated with chronic intestinal inflammation. On multivariable analysis, no variable reached statistical significance. On subgroup analysis, duration of intestinal failure, location of inflammation, and worst degree of inflammation on histology were associated with escalation of therapy.
Conclusions:
PN dependence and intestinal dysbiosis are associated with chronic intestinal inflammation in children with intestinal failure. Severity of inflammation is associated with escalation of therapy. Further analysis is needed to assess these associations and the efficacy of treatments in this population.
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