Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Article first Published online 24 February 2014
1Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy;
2Gastroenterology and Nutrition Unit, Meyer Pediatric Hospital, Florence, Italy;
3Gastroenterology and Endoscopy Unit, G. Gaslini Institute for Children, Genoa, Italy;
4Department of Pediatric Gastroenterology, University of Padua, Padua, Italy;
5Pediatric Gastroenterology, University of Messina, Messina, Italy;
6Pediatric Department, Buzzi Children's Hospital of Milan, Milan, Italy;
7Pediatric Gastroenterology and Endoscopy, University of Messina, Messina, Italy;
8Pediatric Gastroenterology and Endoscopy Unit, Spirito Santo Hospital, Pescara, Italy;
9Department of Pediatrics, University of Naples Federico II, Naples, Italy;
10Pediatric Department, Maggiore Hospital, Bologna, Italy;
11Pediatric Department, Giovanni XXIII Hospital, Bari, Italy;
12Pediatric Gastroenterology Unit, University of Turin, Turin, Italy;
13Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; and
14Department of Pediatrics, Institute of Child Health, IRCSS Burlo Garofalo, Trieste, Italy.
Reprints: Stefano Martelossi, MD, Department of Pediatrics, Institute of Child Health, IRCSS Burlo Garofalo, Via dell'Istria, 65, Trieste 34137, Italy (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
Received December 19, 2013
Accepted January 06, 2014