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[Inflammatory bowel diseases in children]
E Langholz1, P Munkholm, P A Krasilnikoff
1Amtssygehuset i Herlev, medicinsk gastroenterologisk afdeling C.
Insights
Pediatric inflammatory bowel disease (IBD) incidence is low, with children experiencing more extensive ulcerative colitis (UC) at diagnosis. Crohn's disease (CD) in children shows similar outcomes to adults, though growth issues are noted.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology of Inflammatory Bowel Disease
Background:
- Inflammatory Bowel Disease (IBD) affects children and adults, but pediatric onset may have unique characteristics.
- Understanding the incidence, presentation, and prognosis of childhood IBD is crucial for effective management.
Purpose of the Study:
- To determine the incidence of IBD in children under 15.
- To compare the clinical course and prognosis of pediatric-onset IBD with adult-onset IBD.
Main Methods:
- Analysis of an incidence cohort diagnosed between 1962-1987.
- Identification of patients with IBD onset before age 15.
- Comparison of disease characteristics, activity, colectomy rates, and long-term outcomes between pediatric and adult cohorts.
Main Results:
- Mean incidence of pediatric IBD was 2.2/10(5) (UC: 2.0, CD: 0.2).
- Children with UC presented with more extensive disease and frequent abdominal pain compared to adults.
- Colectomy rates and disease activity (remission rates) were similar between pediatric and adult UC patients.
- Pediatric Crohn's disease (CD) showed no significant differences in presentation, course, or prognosis compared to adult CD.
- Growth retardation was a significant issue in pediatric CD patients at diagnosis; one UC patient developed colon cancer after 12 years.
Conclusions:
- Childhood IBD incidence is low, with UC presenting more extensively in children.
- Pediatric CD course and prognosis mirror adult CD, but growth retardation is a key concern.
- Long-term outcomes like colectomy rates and disease activity are comparable between pediatric and adult IBD patients.
Abstract:
From an incidence cohort diagnosed during 1962-1987 we identified all patients with onset of IBD before the age of 15 in order to describe the course and to compare course and prognosis with adult onset IBD. The mean incidence of IBD among children below 15 years was 2.2/10(5), 2.0 for ulcerative colitis (UC), and 0.2 for Crohns disease (CD). At diagnosis, UC children had more extensive disease compared to adults (p < 0.05). Abdominal pains were also more frequent. The cumulative colectomy probability was 6% after one year and 29% after 20 years, not different from adults. Regarding disease activity, it was found that 60-70% of UC patients were in remission in the first 10 years of disease, for CD about 50% were in remission. One UC patient developed carcinoma of the sigmoid colon. Time between onset and development of carcinoma was 12 years. For CD no differences in clinical appearance at diagnosis and course between children and adults were found. No deaths occurred among CD patients. Three CD patients were found to have severe growth retardation already at diagnosis. In conclusion, the incidence of IBD is low in childhood. At diagnosis children with UC have more widespread disease than adults. Children with CD do not differ in clinical presentation, course or prognosis compared to adult onset CD. However, growth retardation is a problem among CD patients.