Phenotype and Disease Course of Early-onset Pediatric Inflammatory Bowel Disease

• DOI: 10.1097/01.mib.0000442921.77945.09
• Publication Date: 2014-02-25T10:21:54Z
• Authors: Marina Aloi; Paolo Lionetti; Arrigo Barabino; Graziella Guariso; Stefano Costa; Massimo Fontana; Claudio Romano; Giuliano Lombardi; Erasmo Miele; Patrizia Alvisi; Paolo Diaferia; Maurizio Baldi; Vittorio Romagnoli; Marco Gasparetto; Monica Di Paola; Monica Muraca; Salvatore Pellegrino; Salvatore Cucchiara; Stefano Martelossi
• Keywords: Children; Early onset; Inflammatory bowel disease; Adolescent; Age of Onset; Child; Child, Preschool; Colitis, Ulcerative; Crohn Disease; Disease Progression; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Phenotype; Severity of Illness Index; Immunology and Allergy; Gastroenterology; Male; Adolescent; Infant, Newborn; Infant; Severity of Illness Index; Inflammatory bowel disease; 3. Good health; 03 medical and health sciences; Phenotype; 0302 clinical medicine; Crohn Disease; Child, Preschool; Disease Progression; Humans; Colitis, Ulcerative; Female; Age of Onset; Child; inflammatory bowel disease; early onset; children; Follow-Up Studies

Early-onset (EO) pediatric inflammatory bowel diseases (IBD) seem to be more extensive than those with a later onset. To test this hypothesis, we examined the phenotype and disease course of patients with IBD diagnosis at 0 to 5 years, compared with the ranges 6 to 11 and 12 to 18 years.Anatomic locations and behaviors were assessed according to Paris classification in 506 consecutive patients: 224 Crohn's disease, 245 ulcerative colitis, and 37 IBD-unclassified.Eleven percent of patients were in the range 0 to 5 years, 39% in 6 to 11 years, and 50% in 12 to 18 years. Ulcerative colitis was the most frequent diagnosis in EO-IBD and in 6- to 11-year-old group, whereas Crohn's disease was predominant in older children. A classification as IBD-unclassified was more common in the range 0 to 5 years compared with the other groups (P < 0.005). EO Crohn's disease showed a more frequent isolated colonic (P < 0.005) and upper gastrointestinal involvement than later-onset disease. Sixty-two percent of the patients in the 0 to 5 years range had pancolonic ulcerative colitis, compared with 38% of 6 to 11 years (P = 0.02) and 31% of 12-18 years (P = 0.002) range. No statistical difference for family history for IBD was found in the 3-year age groups. Therapies at the diagnosis were similar for all children. However, at latest follow-up, a significantly higher proportion of younger children were under steroids compared with older groups (P < 0.05). Surgical risk did not differ according to age.EO-IBD exhibits an extensive phenotype and benefit from aggressive treatment strategies, although surgical risk is similar to later-onset disease. A family history for IBD is not common in EO disease.