Paediatric inflammatory bowel disease: Clinical presentation and disease location

Abstract

Objective:To determine different clinical presentationsand disease location demarcatedby upper and lower gastrointestinal endoscopyand relevant histopathologyin children diagnosed with inflammatory bowel disease (IBD).Methods:This is 5 years (2010 to 2015) retrospective studyconducted at the Aga Khan University Hospitalenrolling65admitted children between 6 months to 15years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by paediatric gastroenterologists at endoscopy suite of the hospital and all specimens were reported by the pathology department. ESPGHAN revised criteria for the diagnosis of inflammatory bowel disease in children and an adolescent was used to standardize our diagnosis. Extent of disease on endoscopy and relevant histopathology of the biopsy samples were noted at the time of diagnosis. Data was summarized using mean, standard deviation, numbers and percentages for different variables.Results:Total 56 children were enrolled according to inclusion criteria. There were 34children (61.53%) diagnosed with ulcerative colitis (UC), 10 patients (16.92%) had Crohn’sDisease (CD) and 11 (21.53%) patients were labeled as Indeterminate colitis (IC). Mean age at onset of symptoms was10.03±2.44 and mean age at diagnosis was11.10±2.36. Abdominal pain (80%) and chronic diarrhea (70%) were common symptoms in CD whereas bloody diarrhea (79.41%) and rectal bleeding(64.70%)were common presentation in UC. Patients diagnosed with indeterminate colitis(IC) had similar clinical features as in UC patients. Only 7% patients had some extra-intestinal features in the form of joint pain and/or uveitis. Aspartate aminotransferase level (95.18 ±12.89) was relatively high in patients withCD in comparison with other categories of IBD. Endoscopic findings and relevant histopathology of biopsy samples in UC showed 65% patient had pan-colitis and 13 % with disease restricted to rectum only whereas in CD 70% patient had disease in ileo-colon and only 10 % had involvement of ileum at the time diagnosis.Conclusion:Patients with UC dominated in our cohort. The most common clinical presentation in UC was bloody diarrhea and rectal bleeding and patients with CDhad abdominal pain and chronic diarrhea as predominant clinical features. Extraintestinal features were uncommon in our cohort. In endoscopic findings, pan-colitis was the mostfrequentfinding in UC and ileo-colonwas common location in CD. IC and UC shared common clinical features and disease location on endoscopy.

Letter in Reply: Pediatric Crohn’s Disease in Bahrain

“…5 Similar to our study where only major EIMs were considered, oral manifestations were not considered as a major EIMs in other studies. 2,3,6,7 In our study, if we added minor EIMs, the prevalence would reach 28.8%. 2…”

“…4 A study from Hungary reported EIMs in 30% of 331 patients with Crohn’s disease (CD), another study from Pakistan reported EIMs in 7% of 56 patients with IBD. 4,6 Defining the true prevalence of EIMs in patients with IBD is difficult. 3 Differences in study designs and methodology might explain the variation in the prevalence of EIMs.…”

“…If all possible systemic effects secondary to the disease or its medical therapy were included, then almost all patients will have EIMs. 3,4,6 For example, in a study from Saudi Arabia, EIMs were reported in 23 (24%) out of 96 pediatric patients with CD. 5 However, the most common EIMs in his cohort were oral manifestation (18 patients), and only five patients had major EIMs (eye involvements in two, autoimmune hepatitis in two, arthritis and skin vasculitis in one patient each).…”

Inflammatory Bowel Disease in Children: Experience and Constraints in a Resource-limited Setting

“…Individuals with UC tend to present with recurrent abdominal pain, rectal bleeding, and bloody diarrhea, while patients with CD may present with extraintestinal manifestations such as poor growth, weight loss, musculoskeletal diseases, hepatobiliary diseases, ocular diseases, and renal diseases. Endoscopic findings of UC tend to be more of a uniformly diffuse inflammation of the gut that involves the mucosa and submucosa, while CD typically shows patchy (skip) lesions, transmural gut involvement with or without abscesses, and granulomas [2][3]. The etiology of IBD, though not fully elucidated, is believed to be multifactorial and results from an interplay of genetic predisposition, environmental factors, and immune dysregulation, which ultimately results in chronic inflammation of the gut [2][3][4][5].…”

“…Endoscopic findings of UC tend to be more of a uniformly diffuse inflammation of the gut that involves the mucosa and submucosa, while CD typically shows patchy (skip) lesions, transmural gut involvement with or without abscesses, and granulomas [2][3]. The etiology of IBD, though not fully elucidated, is believed to be multifactorial and results from an interplay of genetic predisposition, environmental factors, and immune dysregulation, which ultimately results in chronic inflammation of the gut [2][3][4][5].…”