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Clinical Course of Very Early-Onset Inflammatory Bowel Disease
Ugo Cucinotta1, Serena Arrigo2, Valeria Dipasquale1
1From the Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
Insights
Very early-onset inflammatory bowel disease (VEO-IBD) patients often present with more severe disease and poorer treatment responses compared to older pediatric IBD patients. VEO-IBD may necessitate more frequent surgeries and show reduced effectiveness of steroid and anti-tumor necrosis factor-alpha therapies.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes Analysis
Background:
- Limited data exists on the clinical characteristics and outcomes of very early-onset inflammatory bowel disease (VEO-IBD).
- Understanding VEO-IBD is crucial for optimizing management strategies in young children.
- Comparing VEO-IBD with later-onset pediatric IBD (P-IBD) can reveal distinct disease trajectories.
Purpose of the Study:
- To delineate the clinical features and disease outcomes of VEO-IBD patients.
- To assess the treatment response to steroids and anti-tumor necrosis factor (TNF)-α agents in VEO-IBD.
- To compare VEO-IBD patients with a cohort of P-IBD patients.
Main Methods:
- A comparative study included consecutive patients aged 0-6 years (VEO-IBD) and 6-17 years (P-IBD).
- Diagnoses included Crohn disease (CD), ulcerative colitis, and IBD unclassified (IBD-U).
- Outcomes assessed included clinical remission, steroid resistance/dependence, anti-TNF-α agent retention, and surgical risk.
Main Results:
- IBD unclassified was more prevalent in VEO-IBD (28%) than P-IBD (3%), while CD predominated in older children (52% vs 27%).
- VEO-IBD patients exhibited lower steroid remission rates (82% vs 93%), higher steroid resistance (14% vs 5%), and increased steroid dependence (27% vs 8%).
- Anti-TNF-α retention was significantly lower in VEO-IBD at 1 and 2 years (59% vs 85%; 16% vs 55%), with higher surgical risk (32% vs 14%).
Conclusions:
- VEO-IBD patients may experience a more severe disease course than P-IBD patients.
- Response to steroids and anti-tumor necrosis factor (TNF)-α agents appears less favorable in VEO-IBD.
- VEO-IBD is associated with a higher likelihood of requiring surgical interventions.
Objectives:
Data on the phenotypes and disease outcomes of very early-onset inflammatory bowel disease (VEO-IBD) are limited. The aims of this study were to describe the clinical features, outcomes, and treatment response of VEO-IBD patients and to compare them with later-onset pediatric inflammatory bowel disease (P-IBD) patients.
Methods:
All consecutive patients aged 0-6 years who were diagnosed with Crohn disease (CD), ulcerative colitis, or IBD unclassified (IBD-U) at 2 academic hospitals from 2010 to March 2021 were included. They were compared to sex-matched IBD patients aged 6-17 years.
Results:
Two hundred thirty-two patients were included, 78 (34%) with VEO-IBD and 154 (66%) with P-IBD. IBD-U was the most common diagnosis in the VEO-IBD group compared to P-IBD (28% vs 3%, P < 0.001), while CD was predominant in older children (27% vs 52%, P < 0.001). The VEO-IBD group showed lower rates of clinical remission after induction with steroids compared to older children (82% vs 93%, P = 0.01), higher rates of steroid resistance (14% vs 5%, P = 0.02), and steroid dependence (27% vs 8%, P < 0.001). The number of patients who started anti-tumor necrosis factor (TNF)-α agents was similar between the groups. Anti-TNF-α retention was lower in the VEO-IBD group at 1 and 2 years (59% vs 85%, P = 0.003; 16% vs 55%, P < 0.001, respectively). Surgical risk appeared to be higher for VEO-IBD (32% vs 14%, P < 0.001).
Conclusions:
When compared to P-IBD patients, patients with VEO-IBD may have a more severe disease course, a poorer response to steroids and anti-TNF-α agents, and require more frequent surgical procedures.
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