Impact of Extra-Intestinal Manifestations at Diagnosis on Disease Outcome in Pediatric- and Elderly-Onset Crohn′s Disease: A French Population-Based Study

Ďuricová, Dana; Sarter, Hélène; Leroyer, Ariane; Armengol-Debeir, Laura; Bouguen, Guillaume; Ley, Delphine; Templier, C.; Buche, S.; Peyrin–Biroulet, Laurent; Gower‐Rousseau, Corinne; André, J; Antonietti, Michel; Aouakli, A.; Armand, A.; Aroichane, I; F, Assi; Aubet, J P; Auxenfants, É.; Ayafi-Ramelot, F; Bankovski, D; Barbry, B; Bardoux, N; Baron, Philippe; Baudet, A; Bazin, Brigitte; A, Bebahani; Becqwort, J P; Benet, V; Benali, Habib; Benguigui, C; Soussan, Emmanuel Ben; Bental, A.; Berkelmans, Isabelle; Bernet, J.; Bernou, K; C, Bernou-Dron; P, Bertot; Bertiaux-Vandaële, Nathalie; Bertrand, Valérie; Billoud, E; Biron, N; Bismuth, B.; Bleuet, M; Blondel, F; Blondin, V.; Bohon, P; Boniface, Eric; Bonnière, P; Bonvarlet, E; Bonvarlet, P; Boruchowicz, A; R, Bostvironnois; Boualit, Médina; Bouche, B; Boudaillez, C; Bourgeaux, C; Bourgeois, Marie; Bourguet, Aurélie; Bourienne, A; Branche, Julien; Bray, George A.; Brazier, Franck; P, Breban; Brihier, Hélène; Brung-Lefebvre, V; Bulois, P.; P, Burgiere; Butel, J; Canva, Jean-Yves; Canva-Delcambre, V.; Capron, J P; Cardot, F; Carpentier, P.; Cartier, E; Cassar, JoAnn; Cassagnou, Michel; Castex, J F; Catala, Pascale; Cattan, Stéphane; Catteau, Sylviane; Caujolle, B.; Cayron, G; Chandelier, C; Chantre, M; Charles, J.; T, Charneau; M, Chavance-Thelu; Chirita, Dragos; Choteau, A; Claerbout, Jean-François; Clergue, P Y; Coevoet, Hugues; Cohen, Glenn D.; Collet, R.; Colombel, J F; Coopman, Stéphanie; Corvisart, J; Cortot, Antoine; Couttenier, F.; Crinquette, J; Crombé, Valérie; Dadamessi, Innocenti; Dapvril, V; Davion, T; Dautreme, S; J, Debas; DeGrave, Nicole; Dehont, F; Delatre, C; Delcenserie, Richard; Delette, O; Delgrange, T; Delhoustal, L; Delmotte, J. S.; Demmane, S; Deregnaucourt, G; Descombes, P; Desechalliers, J P; DeSmet, Pagm; Desreumaux, Pierre; Desseaux, G; Desurmont, Philippe; Devienne, A; Devouge, Eve; Devred, M; A, Devroux; Dewailly, A.; Dharancy, Sébastien; Fiore, A. Di; Djeddi, D.; Djedir, R; Dreher-Duwat, M L; Dubois, Raymond.; Dubuque, Christopher R; Ducatillon, P; Duclay, J; B, Ducrocq; Ducrot, F; Ducrotté, P; Dufilho, A; C, Duhamel; Dujardin, D; Dumant-Forest, Clémentine; Dupas, Jean Louis; Dupont, F; Duranton, Y; Duriez, Arnaud; Achkar, K.; Farisi, M El; Elie, Caroline; Elie-Legrand, M C; A, Elkhaki; Eoche, Matthieu; Evrard, Diane; Evrard, Jacques; Fatome, A; Filoche, B; Finet, L; M, Flahaut; Flamme, C; Foissey, David; Fournier, Pierre; Comes, Marie-Christine; Foutrein, P.; Fremond, D; Frere, T; Fuméry, Mathurin; Gallet, P.; Gamblin, C; Ganga-Zandzou, S.; Gérard, Romain; Geslin, Guillaume; Gheyssens, Y; N, Ghossini; Ghrib, S.; Gilbert, T; Gillet, Brigitte; Godard, D.; Godard, P.; Godchaux, J. M.; R, Godchaux; Goegebeur, Guetty; Goria, Odile; Gottrand, Frédéric; Gower, P. E.; Grandmaison, B; Groux, M; Guédon, Claire; Guillard, J; Guillem, Laurence; Guillemot, François; Guimber, D.; Haddouche, Baya; Hakim, Seifeldin; Hanon, D; Hautefeuille, Vincent; P, Heckestweiller; Hecquet, G; Hedde, J. P.; Hellal, H; Henneresse, Pierre-Emmanuel; Heyman, B.; Héraud, M; Hervé, Sophie; Hochain, P; L, Houssin-Bailly; Houcke, Philippe; Huguenin, B.; Iobagiu, Silviu; Ivanović, Aleksandar; Iwanicki–Caron, Isabelle; Janicki, Eric; Jarry, Marine; J, Jeu; Joly, Johan; Jonas, C.; Katherin, F; Kerleveo, A; Khachfe, A; A, Kiriakos; J, Kiriakos; Klein, Olivier; Kohut, Mathieu; R, Kornhauser; Koutsomanis, Demetrios; Labérenne, Jean-Eric; G, Laffineur; Lagarde, María; Lannoy, P; J, Lapchin; Lapprand, M.; Laude, D; LeBlanc, Robert E.; Lecieux, P; Leclerc, Nicolas; Couteulx, Christian Le; Ledent, Jacques; Lefèbvre, J; Lefiliatre, P; Legrand, Céline; Grix, A Le; Lelong, Patrick; Leluyer, B; Lenaerts, C.; Lepileur, L; A, Leplat; Lepoutre-Dujardin, E; Leroi, H; Leroy, Mélanie; Lesage, Jacques; Lesage, Xavier; Lescanne-Darchis, I; Lescut, J; Lescut, D.; Leurent, Bruno; Lévy, Patrick; M, Lhermie; Lion, A; Lisambert, B; Loire, F; Louf, S; Louvet, Alexandre; Luciani, Marília Gabriela; Lucidarme, Damien; J, Lugand; Macaigne, O.; Maetz, D; Maillard, Dominique; Mancheron, H; Manolache, O; Marks-Brunel, Anne-Bérangère; Marti, Raymond; Martín, F; Martin, George M.; Marzloff, E; Maury, Philippe; Mauillon, Jacques; Maunoury, V.; Maupas, Jean; Mesnard, B; Métayer, P. Le; L, Methari; B, Meurisse; Meurisse, F; Michaud, Laurent; Mirmaran, X; Modaine, P; A, Monthe; Morel, Laurence; Mortier, Pierre-Eugène; Moulin, E; Mouterde, O.; Mudry, J; Nachury, Maria; Khac, Eric Nguyen; Notteghem, B; Ollevier, V; A, Ostyn; Ouraghi, A; Ouvry, D; Paillot, B; Panien-Claudot, N; Paoletti, Catherine; Papazian, A.; Parent, Bénédicte; Pariente, Benjamin; Paris, J; P, Patrier; L, Paupart; Pauwels, Bart; Pauwels, Marina; Petit, Richard E.; Piat, M; Piotte, S; Plane, C; Plouvier, B; Pollet, Éric; Pommelet, P; D, Pop; Pordes, C; Pouchain, G; Prades, P; Prevost, A Toby; Prevost, Jean-Briac; Quesnel, Bruno; Queuniet, A M; Quinton, Jean-François; A, Rabache; P, Rabelle; G, Raclot; S, Ratajczyk; Rault, D; Razemon, V; Reix, N; Revillon, M; Richez, Christophe; Robinson, Paul D.; Rodriguez, J. Rubén; Röger, J; Roux, Jean-Jacques; Rudelli, A.; Saber, Azadeh; Savoye, Guillaume; Schlosseberg, P; Segrestin, M; Séguy, D.; Serin, Mine; A, Seryer; Sévenet, F; Shekh, N; Silvie, J; Simon, Viviana; Spyckerelle, C.; Talbodec, N.; Techy, Aurore G.; Thelu, J L; Thevenin, Alain; Thiebault, Henri; Thomas, James; Thorel, Jean-Baptiste; Tielman, Guillaume; Tode, M; Toisin, J; Tonnel, J; Touchais, J. Y.; Touze, Y; Tranvouez, J. L.; Triplet, C; Turck, Dominique; Uhlen, S; Vaillant, Emmanuel; C, Valmage; Vanco, D; Vandamme, H; E, Vanderbecq; Eecken, E Vander; Vandermolen, P; Vandevenne, P.; L, Vandeville; A, Vandewalle; Vandewalle, Christina; P, Vaneslander; Vanhoove, J P; Vanrenterghem, A.; Varlet, Pascale; Vasies, I.; G, Verbiese; Vernier‐Massouille, Gwénola; Vermelle, P; C, Verne; Vezilier-Cocq, P; Vigneron, Benoît; Vincendet, M; Viot, Julien; Voiment, Y M; Wacrenier, Adrien; Waeghemaecker, L; Wallez, J Y; Wantiez, M; Wartel, F.; Weber, J; Willocquet, J L; Wizla, N.; Wolschies, E; Zalar, Alberto; B, Zaouri; Zellweger, A.; Ziadé, Caroline

doi:10.1093/ibd/izy254

Cited by 23 publications

(14 citation statements)

References 30 publications

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“…As well as a presentation with the above GI symptoms, some children will have involvement of the liver or other features outside the gut. 21 IBD-associated liver disease can involve predominantly auto-immune hepatitis, sclerosing cholangitis or overlap (with features of both). Extra-intestinal manifestations of IBD can be present at diagnosis or develop subsequently, in up to 30% of individuals.…”

Section: Presentation Of Ibd In Childrenmentioning

confidence: 99%

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Identification and diagnosis of Crohn disease and ulcerative colitis in children

Day

Lemberg

2020

J Paediatrics Child Health

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Crohn disease and ulcerative colitis are the two main types of inflammatory bowel disease. High rates of these conditions are seen in Australasian childrenfurthermore, increasing rates have been evident in recent years. Children can present with typical symptoms of abdominal pain, diarrhoea, haematochezia and/or weight loss. Atypical presentations (such as skin lesions or isolated short stature) can also occur: these may be associated with delays in the consideration and diagnosis of IBD. Initial steps in establishing a diagnosis of IBD include delineation of inflammatory markers exclusion of any other likely aetiology. Definitive diagnosis relies upon key endoscopic, histologic and radiological findings. Overall management of IBD encompasses care within a team-based, child and family-focused, multidisciplinary setting.

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Section: Presentation Of Ibd In Childrenmentioning

confidence: 99%

“…Extra-intestinal manifestations of IBD can be present at diagnosis or develop subsequently, in up to 30% of individuals. 21 Extra-intestinal manifestations include skin lesions (e.g. erythema nodosum and pyoderma gangrenosum), joint symptoms (arthritis), liver disease or eye manifestations (such as uveitis and iritis).…”

Section: Presentation Of Ibd In Childrenmentioning

confidence: 99%

Identification and diagnosis of Crohn disease and ulcerative colitis in children

Day

Lemberg

2020

J Paediatrics Child Health

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“…There are approximately 80,000 patients with UC in France (EPIMAD register [40]), and as many as 10% to 20% will undergo proctocolectomy with IPAA as a result of refractory disease, dysplasia, or malignancies. Approximately 50% of people who have had an IPAA will develop pouchitis in the following years.…”

Section: Study Population -Patientsmentioning

confidence: 99%

Impact of fecal microbiota transplantation on chronic recurrent pouchitis in ulcerative colitis with ileo-anal anastomosis: study protocol for a prospective, multicenter, double-blind, randomized, controlled trial

Trang-Poisson

Kerdreux

Poinas

et al. 2020

Preprint

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- Background: Almost 15 % of patients with ulcerative colitis (UC) will require a proctocolectomy with ileal pouch–anal anastomosis (IPAA) as a result of fulminant colitis, dysplasia, cancer, or medical refractory diseases. Around 50% will experience pouchitis, an idiopathic inflammatory condition involving the ileal reservoir, responsible for digestive symptoms, deterioration in quality of life, and disability. Though the majority of initial cases of pouchitis are easily managed with a short course of antibiotics, in about 10% of cases, inflammation of the pouch becomes chronic with very few treatments available. Previous studies have suggested that manipulating the composition of intestinal flora through antibiotics, probiotics, and prebiotics achieved significant results for treating acute episodes of UC-associated pouchitis. However, currently there is no established effective treatment for chronic antibiotic-dependent pouchitis. Fecal microbiota transplantation (FMT) is a novel therapy involving the transfer of normal intestinal flora from a healthy donor to a patient with a medical condition potentially caused by the disrupted homeostasis of intestinal microbiota or dysbiosis.-Methods Our project aims to compare the delay of relapse of chronic recurrent pouchitis after FMT versus sham transplantation. Forty-two patients with active recurrent pouchitis after having undergone an IPAA for UC will be enrolled at 12 French centers. The patients who respond to antibiotherapy will be randomized at a ratio of 1:1 to receive either FMT or sham transplantation.-Discussion : On April 30, 2014, WHO published an alarming report on antibiotic resistance. Finding an alternative medical treatment to antibiotics in order to prevent relapses of pouchitis is therefore becoming increasingly important given the risk posed by multiresistant bacteria. Moreover, if the results of this study are conclusive, FMT, which is less expensive than biologics, could become a routine treatment in the future.-Trial registration: The trial, published on May 14, 2018, is registered at ClinicalTrials.Gov under registration number NCT03524352: https://clinicaltrials.gov/ct2/show/NCT03524352term=NCT03524352&rank=1

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“…Duricova et al compared the occurrence of EIMs in paediatric and elderly patients with UC and CD from a French prospective population-based registry [EPIMAD] [14,15]. At the time of diagnosis, EIMs were seen in 8.9% of 158 children with UC and 23.5% of 535 children with CD, while 29.8% of paediatric CD sufferers developed EIM during the follow-up.…”

Section: Prevalence and Types Of Immune-related Extraintestinal Manifmentioning

confidence: 99%

Extraintestinal manifestations in paediatric-onset inflammatory bowel disease depending on disease location and activity

Niewiem¹,

Buczyńska²,

Flak-Wancerz³

et al. 2019

polp

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Aim of the study: The aim of the study was to determine the prevalence and types of extraintestinal manifestations (EIMs) in paediatric-onset inflammatory bowel diseases (IBD), i.e. Crohn's disease (CD) and ulcerative colitis (UC), depending on disease activity and location, and to determine whether the presence of EIM is associated with a distinctive clinical course of IBD. Material and methods: The medical records of 287 children with IBD with or without EIMs were retrospectively analysed, especially regarding the following characteristics: age at diagnosis, clinical symptoms, nutritional status, the Paris Classification, and IBD activity. Results: The study population of 287 children comprised 147 patients with UC (mean age 12.9 years) and 140 patients with CD (mean age 14.1 years). EIMs were diagnosed in 60 patients (20.9%). The most frequent immune-related EIM in UC patients was primary sclerosing cholangitis (PSC); the collective proportion of PSC and PSC/autoimmune hepatitis (AIH) was 14.9%. Arthropathy was the most prevalent EIM in the subpopulation of CD participants (10%). Pancolitis was a risk factor for EIMs in the UC patients (E4/E0-3 OR 2.3, 95% CI 1.05-5.06, p = 0.037), and especially for PSC and AIH/PSC (OR 2.77, 95% CI 1.09-7.06, p = 0.032). Nevertheless, patients with EIMs presented with bloody diarrhoea less frequently (69% vs. 90%, p = 0.011). The CD EIM(+) and EIM(-) patients did not differ significantly regarding the symptoms at hospital admission. No correlation was revealed between disease location or behaviour and EIM occurrence. The impact of the presence of EIM on CD activity is inconclusive. Conclusions: EIMs are a significant issue in the population of children with IBD; they developed in 20.9% of our patients. Determination of the prevalence of these manifestations and related risk factors might raise awareness of the problem and facilitate diagnosis and therapy.

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Impact of Extra-Intestinal Manifestations at Diagnosis on Disease Outcome in Pediatric- and Elderly-Onset Crohn′s Disease: A French Population-Based Study

Abstract: Extraintestinal manifestations occurred at lower frequency in elderly-onset compared with pediatric-onset patients. In both age populations, presence of EIM at diagnosis independently increased the need for corticosteroid and immunosuppressive treatment.

Cited by 23 publications

References 30 publications

Identification and diagnosis of Crohn disease and ulcerative colitis in children

Identification and diagnosis of Crohn disease and ulcerative colitis in children

Impact of fecal microbiota transplantation on chronic recurrent pouchitis in ulcerative colitis with ileo-anal anastomosis: study protocol for a prospective, multicenter, double-blind, randomized, controlled trial

Extraintestinal manifestations in paediatric-onset inflammatory bowel disease depending on disease location and activity

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