Purpose: The evidence for an association between inflammatory bowel disease (IBD) and obesity is conflicting. Therefore, we set out to review the body mass index (BMI) at presentation of IBD to understand if the rise of the obesity rate in the general population, lead to an increase of obesity in patients with IBD at the time of diagnosis. Methods: Retrospective review of all patients with IBD seen at Children's Hospital and Medical Center from January 1st 2010 to December 31st 2014. From the initial visit and endoscopy, we obtained: age; sex; BMI; disease phenotype; disease severity. Results: We had a total of 95 patients, 35 patients were excluded due to incomplete data or referral being made after diagnosis was made. 28 were males and 32 were females, Age range was 2-17 years. A 37 had Crohn's disease, 19 ulcerative colitis, and 4 indeterminate colitis. Disease severity in 19 cases was mild, 29 moderate and 12 severe. BMI distribution was as follows-obese (5.0%), overweight (6.7%), normal weight (65.0%), mild malnutrition (8.3%), moderate malnutrition (15.0%), severe malnutrition (1.7%). Conclusion: Our data is consistent with other series. Showing most children had a normal BMI, regardless of disease severity or phenotypes. One confounding factor is the possibility of delay in referral to GI. This could mean some obese children may fall in the normal BMI range at the time of diagnosis due to ongoing weight loss. Future studies should include prospective cohort studies, comparing incidence of IBD in obese and non-obese patients, severity at presentation, duration of symptoms, and clinical outcomes.
A 14-year-old Hispanic previously healthy girl presented to the pediatric emergency department with 2-3 months of increasing epigastric abdominal pain. She was brought to the emergency department for an episode of waking pain. Family history was negative for gastric cancer. Physical examination revealed pallor and abdominal tenderness in her epigastrium and left upper quadrant. Initial evaluation revealed anemia (Hb 7.8 g/dL), elevated lipase (133 U/L), erythrocite sedimentation rate 78 mm/hour, aspartate aminotransferase 103 U/L, and alanine aminotransferase 69 U/L. Magnetic resonance enterography showed inflammatory change in the body and tail of the pancreas and prominent pancreatic and gastric lymph nodes. Esophagogastroduodenoscopy revealed a 5-6 cm gastric mass in the posterior wall of the stomach body/fundus with complex ulceration (Fig. 1). Pathologic analysis yielded poorly differentiated primary gastric adenocarcinoma (negative Helicobacter pylori staining) (Fig. 2). Staging studies showed stage IV disease because of tumor size T4b-extension of the mass to the pancreatic tail and left adrenal region, and distant lymph node involvement-Virchow's node. She did not respond to two cycles of chemotherapy. Palliative care was recommended, and she expired within 3 months of diagnosis. Gastrointestinal (GI) malignancy accounts for 5% of all pediatric neoplasms; gastric adenocarcinoma represents 0.05% of all childhood cancers (1).
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