Definition of Phenotypic Characteristics of Childhood-Onset Inflammatory Bowel Disease

Abstract

See Dubinsky MC et al on page 1105 in CGH;See editorial on page 1038. Background & Aims:Childhood-onset inflammatory bowel disease (IBD) might be etiologically different from adult-onset IBD. We analyzed disease phenotypes and progression of childhood-onset disease and compared them with characteristics of adult-onset disease in patients in Scotland. ; 43% vs 3%; P < .0001; OR, 23.36; 95% CI, 13.45-40.59) with less isolated ileal (L1; 2% vs 31%; P < .0001; OR, 0.06; 95% CI, 0.03-0.12) or colonic disease (L2; 15% vs 36%; P < .0001; OR, 0.31; 95% CI, 0.21-0.46). UC was extensive in 82% of the children at diagnosis, versus 48% of adults (P < .0001; OR, 5.08; 95% CI, 2.73-9.45); 46% of the children progressed to develop extensive colitis during followup. Forty-six percent of children with CD and 35% with UC required immunomodulatory therapy within 12 months of diagnosis. The median time to first surgery was longer in childhood-onset than adult-onset patients with CD (13.7 vs 7.8 years; P < .001); the reverse was true

Microbiota of De-Novo Pediatric IBD: Increased Faecalibacterium Prausnitzii and Reduced Bacterial Diversity in Crohn's But Not in Ulcerative Colitis

“…Although genetically similar ( 30 ), there are important distinctions between adult and pediatric IBD with the latter being characterized by a more extensive phenotype ( 31 ) and, at least in the case of CD, by a distinct immunophenotype ( 32 ). Environmental factors such as gastrointestinal microbial colonization may be etiological factors of relevance to this distinction; hence, it is entirely possible that pediatric IBD is defi ned by a unique microbial signature, distinct from the adult disease.…”

Long-term natural history of Crohn’s disease

“…This agedependent phenotypic clinical expression probably reflects the dynamic nature of the disorder [21] . Disease developing earlier in children and adolescents tends to be much more severe, often resulting in significant disease complications, including strictures or fistulae, or both [22][23][24][25] . It is also more extensive, often involving multiple sites in the small and large intestine, with a higher frequency of involvement of the upper gastrointestinal tract [22][23][24][25] .…”

Exclusive enteral nutrition and induction of remission of active Crohn’s disease in children

“…Pediatric CD is often extensive at diagnosis, with almost two-thirds of children having disease proximal to the terminal ileum [3,5]. Perianal and perioral involvement is also observed.…”