Natural History of Pediatric-onset Inflammatory Bowel Disease

Abstract

Background/Aims There has been no systematic review of natural history studies of pediatric-onset inflammatory bowel disease (IBD). We conducted a systematic review focused on understanding the long-term risks of growth failure, disease reclassification and extension, hospitalizations, cancer and death among patients with childhood IBD. Methods PubMed searches and subsequent data abstraction were performed by 2 independent investigators. Studies published full in english with a 5-year minimum average follow-up in at least 30 patients with IBD onset before age 18 years. Results We evaluated 41 total studies (only 2 population-based studies) with 3505 Crohn’s disease (CD) patients, 2071 ulcerative colitis (UC) patients, and 461 indeterminate colitis (IC). Growth failure was reported in CD (10% and 56%) more often than UC 0% to 10%) or non-IBD controls. Improvements in growth occurred after surgical resection in patients with CD. There was an increase in disease reclassification over time from UC and indeterminate colitis diagnosis to CD diagnosis. Patients with CD had higher number of hospitalizations and hospital days per year in comparison with UC patients in most studies. The reported surgery rates in CD ranged between 10% and 72%; the colectomy rates in UC ranged between 0% and 50%. Cancers were reported in 6 CD patients during a total 18,270 patient-years (PY) follow-up, and 8 UC patients in 18,115 PY. Deaths directly related to IBD were 63 during 39,719 PY. Conclusions Childhood-onset IBD patients had growth failure reported in patients with CD more often than those with UC, had a reclassification of disease type to CD over time. Higher rates of surgery and hospitalizations were found with CD than with UC. The risk of cancer and death is low in this population.

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

“…A significantly higher proportion of patients were diagnosed at a young age in the anti-TNF exposed group. Younger patients with CD often have more aggressive disease that may lead to early surgery and requirement of anti-TNF agents [32][33][34][35] . Despite this, anti-TNF exposed still demonstrated longer median time to surgical resection.…”

RECENT RESEARCH ON THE GROWTH PLATE: Impact of inflammatory cytokines on longitudinal bone growth

“…Growth retardation occurs in up to 56% of children with CD and up to 10% of children with UC (Abraham et al 2012), and several publications have reported short stature in JIA patients (Simon 2010). The degree of growth impairment is variable and can range from a mild decrease in growth velocity to severe forms of short stature, which can be defined as a body height more than two S.D.…”

Health Care Use by a Population-Based Cohort of Children With Inflammatory Bowel Disease

“…3,4 There are no data on pediatric health care utilization (HCU) before IBD diagnosis, and limited population-based data on HCU after IBD diagnosis. 5 Exploring the patterns of health care use before chronic disease diagnosis may provide insight into the patterns of diagnostic delay before IBD diagnosis. With increased awareness of IBD and improved access to radiographic and endoscopic diagnostics, it might be expected that time to diagnosis would have been decreasing over recent years.…”