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Clinical and Phenotypic Characteristics of Early-Onset Inflammatory Bowel Disease: A Five-Year Observational Study
Ivan S Samolygo1, Marina A Manina1, Ekaterina A Yablokova2
1Department of Propaedeutics of Children's Diseases, N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., 119991 Moscow, Russia.
Insights
Early-onset inflammatory bowel diseases (EO-IBDs) in children present with distinct features, including family history, moderate-to-high clinical activity, and colon damage. These characteristics aid in timely diagnosis and management of pediatric IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Clinical Phenotyping
Background:
- Early-onset inflammatory bowel diseases (EO-IBDs) represent a distinct subgroup of IBD with unique clinical and phenotypic characteristics.
- Understanding these early-onset features is crucial for accurate diagnosis and management in pediatric populations.
- This study focuses on characterizing EO-IBD in children based on a five-year registry from a specialized center.
Purpose of the Study:
- To delineate the specific clinical, laboratory, and endoscopic features of early-onset inflammatory bowel diseases (EO-IBDs) in a pediatric cohort.
- To identify characteristic signs associated with the development of EO-IBD for improved diagnostic accuracy.
- To compare the presentation and progression of ulcerative colitis (UC) and Crohn's disease (CD) in early-onset cases.
Main Methods:
- Retrospective single-center cohort study of pediatric patients diagnosed with EO-IBD between 2019 and 2024.
- Collection of clinical, laboratory (fecal calprotectin, inflammatory markers), and endoscopic data, including disease activity and severity scores.
- Classification of disease localization (Paris system) and assessment of histological activity (IBD-DCA score).
Main Results:
- The cohort comprised 20 patients with ulcerative colitis (UC) and 17 with Crohn's disease (CD), exhibiting moderate to high clinical activity.
- Distinct symptoms were observed: UC associated with diarrhea and rectal bleeding; CD with abdominal pain, weight loss, and fever; 82.4% of CD patients had an inflammatory form.
- Both UC and CD showed UC-like intestinal lesions (L3 in CD, E4 in UC), moderate morphological activity, and a significant presence of IBD-unclassified (IBD-U) (43.2%). Diagnostic timelines varied, with UC diagnosed sooner (median 24 weeks) than CD (median 40 weeks).
Conclusions:
- Early-onset IBD (EO-IBD) is characterized by a frequent family history, high or moderate clinical activity at diagnosis, colon involvement, and a high incidence of extraintestinal manifestations.
- These findings underscore the importance of recognizing specific clinical and phenotypic patterns for timely diagnosis of pediatric IBD.
- The study highlights characteristic signs aiding in the early identification and management of EO-IBD in children.
Abstract:
Background: Inflammatory bowel diseases with an early-onset form (EO-IBDs) make up a special disease group with certain clinical and phenotypic characteristics. This article discusses the features of such early onset in a group of children, based on five years of monitoring a registry of children with IBD from a specialized center. Methods: This retrospective single-center cohort study included pediatric patients diagnosed with EO-IBD between 2019 and 2024. Clinical, laboratory, and endoscopic data were collected from medical records, including fecal calprotectin, inflammatory markers, disease activity indices, and endoscopic severity scores. Localization was classified according to the Paris system, and histological activity was assessed using the IBD-DCA score. Results: There were 20 patients with ulcerative colitis (UC) and 17 with Crohn's disease (CD). Clinical activity was moderate or high (p = 0.179). UC was more characterized by diarrhea and rectal bleeding. CD was more often accompanied by abdominal pain, weight loss, and fever. In total, 82.4% of patients with CD had an inflammatory form. UC-like intestinal lesion was typical of both nosologies-L3 64.7% and E4 60% forms in CD and UC, respectively. Morphological activity was moderate for both nosologies (p = 0.54). IBD-U was present in 43.2% of patients. The median time after which it was possible to diagnose UC was 24 weeks (IQR 20-48) and 40 weeks (IQR 30-45.5) for CD (p = 0.56). Conclusions: Our study confirms the presence of characteristic signs of EO-IBD development, such as a frequent family history of IBD, high or moderate clinical activity during diagnosis verification, colon damage, and a high frequency of extraintestinal manifestations.
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