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Clinical Features and Outcomes of Very-Early-Onset Inflammatory Bowel Disease in Brazilian Children
Debora Avellaneda Penatti1, Nilton Carlos Machado1, Mary Assis Carvalho1
1From the Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Botucatu Medical School, Unesp-Sao Paulo State University, Botucatu, São Paulo, Brazil.
Insights
Very-early-onset inflammatory bowel disease (IBD) in children presents aggressively. Ulcerative colitis (UC) and Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Pediatrics
Background:
- Very-early-onset inflammatory bowel disease (VEO-IBD) affects children under 6 years.
- IBD diagnosis in young children presents unique challenges.
- Understanding VEO-IBD phenotypes is crucial for early intervention.
Purpose of the Study:
- To characterize clinical, laboratory, and histopathologic findings of treatment-naive VEO-IBD in Brazilian children.
- To differentiate between ulcerative colitis (UC) and Crohn disease (CD) in this cohort.
- To analyze disease severity, extent, and outcomes based on diagnosis.
Main Methods:
- Retrospective review of 20 Brazilian children under 6 years with VEO-IBD.
- Analysis of clinical presentation, laboratory results, and histopathology at diagnosis.
- Classification into UC and CD subtypes, including neonatal-onset and infantile forms.
Main Results:
- 13 children diagnosed with UC, 7 with CD; both severe and extensive at diagnosis.
- UC predominantly pancolonic; CD isolated to the colon with perianal disease.
- CD patients were younger, more nutritionally impaired, and had higher complication rates than UC patients.
Conclusions:
- VEO-IBD exhibits an aggressive clinical course with distinct UC and CD phenotypes.
- Both UC and CD show a preponderance of colonic involvement.
- Differences in severity, behavior, and inflammatory patterns necessitate tailored management strategies.
Abstract:
We report on 20 Brazilian children under 6 years of age with very-early-onset inflammatory bowel disease naive to treatment. The clinical, laboratory, and histopathologic findings at diagnosis and outcomes were reviewed: 13 had ulcerative colitis (UC) and 7 had Crohn disease (CD). The final diagnostic pattern was as follows: 4 children had neonatal-onset (1 UC and 3 CD), 8 had infantile subtype (4 UC and 4 CD), and 8 had UC beyond the neonatal and infantile period. Both forms of inflammatory bowel disease were severe and extensive at diagnosis, with a high prevalence of bloody diarrhea, reflecting the colonic location of the disease. UC was predominantly pancolonic, CD was isolated in the colon and associated with perianal disease. Children with CD were younger than those with UC, were significantly more nutritionally impaired, and had more complications. This study shows that very-early-onset inflammatory bowel disease has an aggressive clinical course with 2 distinct phenotypes, UC and CD, with differences in severity, clinical behavior, and inflammatory pattern but with a preponderance of colonic involvement in both types.
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