Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort
Document Type
Article
Publication Date
9-2015
Abstract
OBJECTIVE:
To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤ 5 years of age) inflammatory bowel disease (IBD).
STUDY DESIGN:
Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America.
RESULTS:
One hundred twelve children were ≤ 5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohn's disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids (P < .01) and methotrexate (P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine (P < .0001) and thiopurine immunomodulators (P < .0002).
CONCLUSIONS:
Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time.
Repository Citation
Olivia-Hemker, M.,
Hutfless, S.,
Al Kazzi, E. S.,
Lerer, T.,
Mack, D.,
LeLeiko, N.,
Griffiths, A.,
Cabrera, J.,
Otley, A.,
Rick, J.,
Bousvaros, A.,
Rosh, J.,
Grossman, A.,
Saeed, S. A.,
Kay, M.,
Carvalho, R.,
Keljo, D.,
Pfefferkorn, M.,
Faubion, W.,
Kappelman, M.,
Sudel, B.,
Schaefer, M. E.,
Markowitz, J.,
& Hyams, J. S.
(2015). Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort. Journal of Pediatrics, 167 (3), 527-532.
https://corescholar.libraries.wright.edu/pediatrics/571
DOI
10.1016/j.jpeds.2015.04.045
PMCID
25982142
