AIMInfantile-onset inflammatory bowel disease (IO-IBD) with the onset of disease before 12 mo of age, is a different disease entity from childhood IBD. We aimed to describe the clinical features, outcome and role of mutation in interleukin-10 (IL-10) and interleukin-10 receptors (IL-10R) in Asian children with IO-IBD.METHODSAll cases of IO-IBD, defined as onset of disease before 12 mo of age, seen at University Malaya Medical Center, Malaysia were reviewed. We performed mutational analysis for IL10 and IL10R genes in patients with presenting clinical features of Crohn’s disease (CD).RESULTSSix [13%; CD = 3, ulcerative colitis (UC) = 2, IBD-unclassified (IBD-U) = 1] of the 48 children (CD = 25; UC = 23) with IBD have IO-IBD. At final review [median (range) duration of follow-up: 6.5 (3.0-20) years], three patients were in remission without immunosuppression [one each for post-colostomy (IBD-U), after standard immunosuppression (CD), and after total colectomy (UC)]. Three patients were on immunosuppression: one (UC) was in remission while two (both CD) had persistent disease. As compared with later-onset disease, IO-IBD were more likely to present with bloody diarrhea (100% vs 55%, P = 0.039) but were similar in terms of an associated autoimmune liver disease (0% vs 19%, P = 0.31), requiring biologics therapy (50% vs 36%, P = 0.40), surgery (50% vs 29%, P = 0.27), or achieving remission (50% vs 64%, P = 0.40). No mutations in either IL10 or IL10R in the three patients with CD and the only patient with IBD-U were identified.CONCLUSIONThe clinical features of IO-IBD in this Asian cohort of children who were negative for IL-10 or IL-10R mutations were variable. As compared to childhood IBD with onset of disease after 12 mo of age, IO-IBD achieved remission at a similar rate.

Background Perianal fistula (PAF) is a disabling complication of Crohn’s disease (CD) and there are few reports about the disease course in Asian population in a population based nationwide scale. We aimed to evaluate the prevalence, clinical course and outcomes of PAF in Taiwanese CD population. Methods By using data from the National Health Insurance, we defined the CD patients and PAF by the ICD coding and filtered by the medication and surgery history. The prevalence, the fistula disease course was analyzed and the outcomes were compared to the CD patients without PAF. Results In this nationwide cohort study, from 2000 to 2017, PAF was diagnosed in 358 (14.6 %) of 2444 CD patients. The majority of CD patients with PAF were men (79.3%). The age of diagnosis for CD was younger in PAF patients (33.7 ± 14.9 years) than those without PAF (45 ± 21.8 years). Approximately half of the PAF occurred before (47.5%) the diagnosis of CD. 33.8% (121/358) patients had recurrent fistula with a median recurrent interval of 239 days (IQR 68–902 days). For CD patients with PAF, they received more often medical treatment including 5-ASA (93.9 vs 67.7 %, p < 0.0001), steroid (94.4 vs 89 %, p < 0.0018), azathioprine (61.7 vs 31.2 %, p < 0.0001) and anti-TNF alpha (44.4 vs 15.1 %, p < 0.0001) and had higher risk of operation (1.4 vs 1.2, p < 0.0032), hospitalization (6.4 vs 3.8, p < 0.0001), Out Patient Clinic (22 vs 6.7, p < 0.0001) and emergency visits (9.7 vs 4.5, p < 0.0001), compared to those without PAF. Although the PAF group needs higher health care utility, the mortality rate is lower than those without PAF (6.7% vs 18.7%, p < 0.0001). Those PAF diagnosed earlier than CD had lower risk of hospitalization (5.1 vs 7.5, p =0.0005) and ER visit (6.3 vs 12.3, p = 0.0056) than PAF diagnosed at the same time or after CD diagnosis. With early use of biologics, patient is associated with lower risk of hospitalization (4.7 vs 9.1, p <0.0001) and ER visit (4.9 vs 13.6, p =0.0116). Conclusion By using the nationwide population database, the prevalence of PAF in Taiwanese CD patients is 14.6 %. The fistula recurrence rate was 33.8%. Patients with PAF required more intensive care and consume more medical resources but they did not have poorer survival status compared to those who do not have PAF. Approximately half of PAF patients presented with perianal symptoms before the diagnosis of CD. Early use of biologics can decrease hospitalization and emergency visit.