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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 MD14on behalf of SIGENP IBD Group

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.

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:

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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