The natural history of pediatric-onset IBD-unclassified and prediction of Crohn’s disease reclassification: a 27-year study

Rinawi, Firas; Assa, Amit; Eliakim, Rami; Mozer‐Glassberg, Yael; Friedler, Vered Nachmias; Niv, Yaron; Rosenbach, Yoram; Silbermintz, Ari; Zevit, Noam; Shamir, Raanan

doi:10.1080/00365521.2017.1282008

Cited by 19 publications

(28 citation statements)

References 26 publications

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“…A shift in IBD diagnosis during a patient's medical history is even more common among patients who are initially diagnosed as IBD-U [12]. Previous studies have reported a shift to either Crohn's disease or ulcerative colitis among 23-84% of these patients [11,[13][14][15][16][17][18]. We previously reported a shift in IBD diagnosis at some point among 18% of patients with IBD in the NPR [12].…”

Section: Discussionmentioning

confidence: 77%

The use of ICD codes to identify IBD subtypes and phenotypes of the Montreal classification in the Swedish National Patient Register

Shrestha

Olén

Eriksson

et al. 2020

Scandinavian Journal of Gastroenterology

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Introduction: Whether data on International Classification of Diseases (ICD)-codes from the Swedish National Patient Register (NPR) correctly correspond to subtypes of inflammatory bowel disease (IBD) and phenotypes of the Montreal classification scheme among patients with prevalent disease is unknown. Materials and methods: We obtained information on IBD subtypes and phenotypes from the medical records of 1403 patients with known IBD who underwent biological treatment at ten Swedish hospitals and retrieved information on their IBD-associated diagnostic codes from the NPR. We used previously described algorithms to define IBD subtypes and phenotypes. Finally, we compared these register-generated subtypes and phenotypes with the corresponding information from the medical records and calculated positive predictive values (PPV) with 95% confidence intervals. Results: Among patients with clinically confirmed disease and diagnostic listings of IBD in the NPR (N ¼ 1401), the PPV was 97 (96-99)% for Crohn's disease, 98 (97-100)% for ulcerative colitis, and 8 (4-11)% for IBD-unclassified. The overall accuracy for age at diagnosis was 95% (when defined as A1, A2, or A3). Examining the validity of codes representing disease phenotype, the PPV was 36 (32-40)% for colonic Crohn's disease (L2), 61 (56-65)% for non-stricturing/non-penetrating Crohn's disease behaviour (B1) and 83 (78-87)% for perianal disease. Correspondingly, the PPV was 80 (71-89)% for proctitis (E1)/left-sided colitis (E2) in ulcerative colitis.

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Section: Discussionmentioning

confidence: 77%

The use of ICD codes to identify IBD subtypes and phenotypes of the Montreal classification in the Swedish National Patient Register

Shrestha

Olén

Eriksson

et al. 2020

Scandinavian Journal of Gastroenterology

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“…In other studies, 23-84% of patients with an initial diagnosis of IBD-U were later classified as UC or CD [9,12,24,[31][32][33]55]. In pediatric patients, a systematic review found an increase in diagnosis of CD over time, and a decrease in IBD-U [7].…”

Section: Discussionmentioning

confidence: 94%

“…The frequency of IBD-U is usually reported to be higher among pediatric patients compared to that of the adult population: 13 versus 6% in a meta-analysis [6], and to be decreasing over disease course [7]. In well characterized IBD cohorts, the proportion of IBD-U has been reported to range from 1 to 20% in adults [8][9][10][11][12][13][14][15][16][17][18][19][20] and from 4 to 22% in pediatric patients [21][22][23][24][25][26][27][28][29][30][31][32][33]) (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients

Everhov

Sachs

Malmborg

et al. 2019

Scandinavian Journal of Gastroenterology

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Aim: To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time. Methods: We examined International Classification of Diseases coding in patients with !2 IBD diagnostic listings in the National Patient Register 2002Register -2014. Results: 18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children). Conclusions: IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.

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“…Differentiating CD from UC is crucial for appropriate medical and surgical management of patients [ 1 2 ]. Some children with inflammatory bowel disease (IBD) do not show the typical endoscopic and histological findings of UC or CD, and up to 30% pediatric patients with IBD are diagnosed with IBD-unclassified (IBDU) [ 3 4 5 6 7 8 9 10 11 12 ]. The revised Porto criteria, the standardized diagnostic criteria for pediatric IBD, recommend using a combination of clinical symptoms, endoscopic findings, and histological findings for diagnosing IBD [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…This emphasizes the importance of evaluating the upper gastrointestinal and small bowel regions beyond colonoscopy at initial diagnosis. Moreover, changes in diagnosis during follow-up have been reported in several studies on pediatric patients with IBD due to the development of small intestinal or perianal lesions and detection of epithelioid cell granulomas on histological analysis [ 3 4 8 9 11 12 14 15 16 ]. However, limited studies have revealed the clinical characteristics of patients whose diagnosis changed from UC to CD and the predictors of this diagnostic change.…”

Section: Introductionmentioning

confidence: 99%

Features and Outcomes of Children with Ulcerative Colitis who Undergo a Diagnostic Change: A Single-Center Experience

Ito

Takeuchi

Kyodo

et al. 2021

Pediatr Gastroenterol Hepatol Nutr

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Purpose A change in diagnosis from ulcerative colitis (UC) to Crohn's disease (CD) has been reported in pediatric inflammatory bowel disease; however, only a few clinical characteristics and predictors of this diagnostic change have been reported. We aimed to describe the clinical characteristics of patients with UC who underwent a change in diagnosis to CD and identify variables associated with the change. Methods The medical records of pediatric patients with UC who were followed up at the National Center for Child Health and Development between 2006 and 2019 were retrospectively reviewed. Clinical data on disease phenotype, laboratory parameters, endoscopic findings, and treatment of patients whose diagnosis changed to CD (cCD) were compared to those of patients whose diagnosis remained UC (rUC). Results Among the 111 patients initially diagnosed with UC, 11 (9.9%) patients were subsequently diagnosed with CD during follow-up. There was no significant difference between the cCD and rUC groups in terms of sex, age at initial diagnosis, and the extent and severity of disease at initial diagnosis. Albumin and hemoglobin levels were significantly lower in the cCD group than in the rUC group. The proportion of patients who required biologics was significantly higher in the cCD group than in the rUC group ( p <0.05). Conclusion Approximately 10% children initially diagnosed with UC were subsequently diagnosed with CD. Hypoalbuminemia and anemia at initial diagnosis and use of biologics could be predictors of this diagnostic change.

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The natural history of pediatric-onset IBD-unclassified and prediction of Crohn’s disease reclassification: a 27-year study

Abstract: In our cohort, a substantial high proportion of pediatric onset IBDU patients were later re-diagnosed as CD. Only a family history of CD and hypoalbuminemia could predict reclassification among IBDU patients.

Cited by 19 publications

References 26 publications

The use of ICD codes to identify IBD subtypes and phenotypes of the Montreal classification in the Swedish National Patient Register

The use of ICD codes to identify IBD subtypes and phenotypes of the Montreal classification in the Swedish National Patient Register

Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients

Features and Outcomes of Children with Ulcerative Colitis who Undergo a Diagnostic Change: A Single-Center Experience

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