Journal of Pediatric Gastroenterology & Nutrition:
Letters to the Editor
Inflammatory Bowel Disease in Pediatric Patients With Cerebral Palsy
Colson, Steven B.; Siparsky, Georgette L.; Capocelli, Kelley E.; Pan, Zhaoxing; Sokol, Ronald J.; Hoffenberg, Edward J.
Children's Hospital Colorado, Aurora
To the Editor:
Cerebral palsy (CP) has not been associated with inflammatory bowel disease (IBD). We have diagnosed IBD in 5 children with CP in the last 2 years. We reviewed our pediatric patients seen from 1996 to 2009 at Children's Hospital, Colorado, with CP and/or IBD and identified 13 with CP and newly diagnosed IBD (6 Crohn disease, 5 ulcerative colitis, and 2 indeterminate colitis), providing an estimate of 1.8% (95% CI 0.97–3.08) for frequency of CP in IBD and an estimated cumulative incidence of 193 (95% CI 103–330) cases with IBD per 100,000 patients with CP.
IBD patients with CP frequently presented with high white blood cell counts, often received infliximab or tacrolimus in the first month following diagnosis, and commonly developed perianal fistula during follow-up. Therefore, we suggest that CP is possibly associated with an aggressive form of IBD. We estimate a prevalence of CP in our patients with IBD (1.8%) that is higher than reported in the general population (0.36%) (1). The estimated cumulative incidence of IBD in our cross-sectional study of pediatric patients with CP was 193/100,000. Although we cannot explain this relation, potential mechanisms include causes of, or treatments for, CP, including special formula diets, that may affect the gastrointestinal microbiota or function (2); an undefined nutritional deficiency (3); and an altered intestinal environment in some children with CP that predisposes to immune dysregulation (4). The possible association between IBD and CP requires further evaluation in population-based studies.
1. Yeargin-Allsopp M, Van Naarden Braun K, Doernberg NS, et al. Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration. Pediatrics 2008; 121:547–554.
2. Abraham C, Medzhitov R. Interactions between the host innate immune system and microbes in inflammatory bowel disease. Gastroenterology 2011; 140:1729–1737.
3. Somerville H, Tzannes G, Wood J, et al. Gastrointestinal and nutritional problems in severe developmental disability. Dev Med Child Neurol 2008; 50:712–716.
4. Strober W, Fuss I, Mannon P. The fundamental basis of inflammatory bowel disease. J Clin Invest 2007; 117:514–521.
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