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Very-early-onset inflammatory bowel disease versus late-onset inflammatory bowel disease in relation to clinical
Hala H Mansour1, Saeed S Seddek2, Manal E Abd E L Meguid2
1Department of Pediatrics, Faculty of Medicine, Cairo University, 2 Yousef Fahmy Street, El-Areech Street, Al-Ahram Street, Giza, 12151, Egypt. hala.h.monsoor@kasralainy.edu.eg.
Insights
Very-early-onset inflammatory bowel disease (VEO-IBD) in children under six presents differently than late-onset IBD (LO-IBD). VEO-IBD often involves the colon, while LO-IBD is more ileocolonic, with varying growth and symptom presentations.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Phenotyping
Background:
- Inflammatory bowel disease (IBD) is a chronic condition impacting children for extended periods.
- Early diagnosis and understanding of IBD in children are crucial due to lifelong implications.
Purpose of the Study:
- To compare the clinical phenotypes of very-early-onset IBD (VEO-IBD) and late-onset IBD (LO-IBD) in children.
- To identify differences in disease presentation and characteristics between pediatric IBD subgroups.
Main Methods:
- A single-center observational cross-sectional study conducted at Cairo University Children's Hospital.
- Inclusion of 197 children diagnosed with IBD between January 2013 and December 2017.
- Comparison of clinical phenotypes between VEO-IBD (age ≤6 years) and LO-IBD (age 6-14 years).
Main Results:
- VEO-IBD predominantly shows a colonic phenotype, whereas LO-IBD is more frequently ileocolonic (p=0.002).
- Growth failure was observed in 14% of VEO-Crohn's disease (VEO-CD) and 31% of late-onset CD (LO-CD) patients.
- VEO-UC patients had less abdominal pain (p=0.001), while LO-UC patients had more hematochezia (p=0.048). VEO-CD showed higher risks of bloody stools, diarrhea, and fever.
Conclusions:
- Pediatric IBD phenotypes vary significantly based on age at diagnosis.
- Understanding these differences is vital for tailored therapeutic interventions and managing long-term outcomes in children with IBD.
Background:
Inflammatory bowel disease (IBD) is a chronic condition and children are affected by the disease's burden and therapeutic interventions for much longer than adults. Children of various ages can be diagnosed with IBD.
Methods:
The research was carried out at the Pediatric Gastroenterology Clinic at Cairo University's Faculty of Medicine's Children's Hospital. From January 2013 to December 2017, this single-center observational cross-sectional study included 197 children aged 14 years and compared the clinical phenotypes of very-early-onset IBD (VEO-IBD) in patients aged six years and late-onset IBD (LO-IBD) in patients aged six to 14 years.
Results:
Children with IBD at less than six years of age have a more colonic phenotype than children diagnosed later in life, who are more likely to have ileocolonic diseases (p = 0.002). In VEO-disease Crohn's (VEO-CD), growth failure/poor weight gain was 14%, while in LO-CD, it was 31%. Children with VEO-IBD do not always present with more severe disease than older children. Most clinical features in children with VEO-ulcerative colitis (VEO-UC) and LO-UC were similar at the first presentation, with the exception of abdominal pain, which was significantly less common in the VEO-UC group (p = 0.001) and hematochezia, which was significantly more common in the LO-UC group (p = 0.048). Children with VEO-disease Crohn's (VEO-CD) had a higher risk of bloody stools, diarrhea and fever (p = 0.013, p = 0.001 and p = 0.008, respectively), but a lower risk of abdominal pain (p = 0.000).
Conclusions:
Growth failure/poor weight gain occurred in 14% of VEO-CD patients and 31% of LO-CD patients. In LO-UC, abdominal pain and hematochezia were significantly more common. In LO-CD, hematochezia, diarrhea and fever were significantly more common. In LO-IBD-U, abdominal pain and diarrhea were significantly more common.
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