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

Aloi, Marina MD, PhD1; Lionetti, Paolo MD, PhD2; Barabino, Arrigo MD3; Guariso, Graziella MD4; Costa, Stefano MD5; Fontana, Massimo MD6; Romano, Claudio MD7; Lombardi, Giuliano MD8; Miele, Erasmo MD9; Alvisi, Patrizia MD10; Diaferia, Paolo MD11; Baldi, Maurizio MD12; Romagnoli, Vittorio MD13; Gasparetto, Marco MD4; Di Paola, Monica PhD2; Muraca, Monica MD3; Pellegrino, Salvatore MD5; Cucchiara, Salvatore MD, PhD1; Martelossi, Stefano MD14; on behalf of SIGENP IBD Group

Inflammatory Bowel Diseases:
doi: 10.1097/01.MIB.0000442921.77945.09
Original Clinical Articles

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.

In Brief

Article first Published online 24 February 2014

Author Information

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:

The authors have no conflicts of interest to disclose.

Received December 19, 2013

Accepted January 06, 2014

© Crohn's & Colitis Foundation of America, Inc.

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