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Impact of Upper Gastrointestinal Involvement on Clinical Outcomes in Paediatric Inflammatory Bowel Disease
Ofek Aloni1,2, Adi Anafy1,2, Hadar Moran-Lev1,2
1Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
Insights
Upper gastrointestinal (UGI) involvement in paediatric inflammatory bowel disease (IBD) is common and linked to a more severe disease course. Early UGI endoscopic evaluation is crucial for effective monitoring and treatment strategies in children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Gastrointestinal Endoscopy
Background:
- Inflammatory Bowel Disease (IBD) management in children requires comprehensive assessment.
- Upper gastrointestinal (UGI) tract involvement is often overlooked in pediatric IBD.
- Understanding UGI involvement's impact is key to optimizing treatment.
Purpose of the Study:
- To evaluate the clinical significance of UGI involvement in pediatric IBD.
- To determine the association between UGI findings and disease severity markers.
- To inform diagnostic and therapeutic strategies for pediatric IBD.
Main Methods:
- Retrospective cohort study of pediatric IBD patients diagnosed between 2010-2023.
- Inclusion criteria: UGI endoscopic evaluation at diagnosis and ≥12 months follow-up.
- Data collected: demographics, clinical, lab, endoscopic, and histologic findings; outcomes assessed.
Main Results:
- UGI involvement detected in 68% of pediatric IBD patients, more frequent in Crohn's disease (CD) than ulcerative colitis (UC).
- Children with UGI involvement showed significantly lower rates of clinical and biomarker remission.
- Increased likelihood of initiating biologic therapy was observed in patients with UGI involvement.
Conclusions:
- UGI involvement signifies a more severe pediatric IBD phenotype.
- Lower remission rates and higher need for biologics correlate with UGI disease.
- Early UGI endoscopic assessment is vital for guiding pediatric IBD management.
Aim:
The aim of this study was to assess the clinical implications of upper gastrointestinal (UGI) involvement in paediatric inflammatory bowel disease (IBD).
Methods:
This retrospective cohort study included children diagnosed with IBD between 2010 and 2023, who underwent a UGI endoscopic evaluation at diagnosis and were followed for at least 12 months. Demographic, clinical, laboratory, endoscopic and histologic data were collected. Outcomes included clinical remission, biomarker remission, need for biologic therapy, IBD-related hospitalizations and IBD-related surgeries.
Results:
UGI involvement was observed in 210 of 310 (68%) children, with a higher prevalence in CD compared to UC (73% vs. 57%, p = 0.004). Children with UGI involvement had a significantly lower probability to achieve clinical remission (Hazard ratio [HR] = 0.76, 95% confidence interval [CI] 0.59-0.98, p = 0.035) and biomarker remission (HR = 0.60, 95% CI 0.45-0.78, p < 0.001) and were more likely to initiate biologic therapy (HR = 1.77, 95% CI 1.24-2.52, p = 0.001).
Conclusion:
UGI involvement is associated with a more severe course of IBD in children and characterized by lower rates of clinical and biomarker remission and a higher likelihood of initiating biologic therapy. These findings highlight the importance of early endoscopic evaluation of the UGI tract in paediatric IBD to guide monitoring and treatment strategies.
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