Title |
Clinical course and outcomes of diagnosing Inflammatory Bowel Disease in children 10 years and under: retrospective cohort study from two tertiary centres in the United Kingdom and in Italy
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Published in |
BMC Gastroenterology, March 2016
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DOI | 10.1186/s12876-016-0455-y |
Pubmed ID | |
Authors |
Marco Gasparetto, Graziella Guariso, Laura Visona’ Dalla Pozza, Alexander Ross, Robert Heuschkel, Matthias Zilbauer |
Abstract |
Most children with Inflammatory Bowel Disease (IBD) are diagnosed between 11 and 16 years of age, commonly presenting with features of typical IBD. Children with onset of gut inflammation under 5 years of age often have a different underlying pathophysiology, one that is genetically and phenotypically distinct from other children with IBD. We therefore set out to assess whether children diagnosed after the age of 5 years, but before the age of 11, have a different clinical presentation and outcome when compared to those presenting later. Retrospective cohort study conducted at two European Paediatric Gastroenterology Units. Two cohorts of children with IBD (total number = 160) were compared: 80 children diagnosed between 5 and 10 years (Group A), versus 80 children diagnosed between 11 and 16 (Group B). Statistical analysis included multiple logistic regression. Group A presented with a greater disease activity (p = 0.05 for Crohn's disease (CD), p = 0.03 for Ulcerative Colitis (UC); Odds Ratio 1.09, 95 % Confidence Interval: 1.02-1.1), and disease extent (L2 location more frequent amongst Group A children with CD (p = 0.05)). No significant differences were observed between age groups in terms of gastro-intestinal and extra-intestinal signs and symptoms at disease presentation, nor was there a difference in the number of hospitalisations due to relapsing IBD during follow-up. However, children in Group A were treated earlier with immunosuppressants and had more frequent endoscopic assessments. While clinicians feel children between 5 and 10 years of age have a more severe disease course than adolescents, our analysis also suggests a greater disease burden in this age group. Nevertheless, randomized trials to document longer-term clinical outcomes are urgently needed, in order to address the question whether a younger age at disease onset should prompt per se a more "aggressive" treatment. We speculate that non-clinical factors (e.g. genetics, epigenetics) may have more potential to predict longer term outcome than simple clinical measures such as age at diagnosis. |
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Geographical breakdown
Country | Count | As % |
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United Kingdom | 1 | 1% |
Unknown | 74 | 96% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Master | 13 | 17% |
Other | 11 | 14% |
Student > Bachelor | 9 | 12% |
Researcher | 9 | 12% |
Student > Ph. D. Student | 9 | 12% |
Other | 12 | 16% |
Unknown | 14 | 18% |
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Biochemistry, Genetics and Molecular Biology | 3 | 4% |
Agricultural and Biological Sciences | 3 | 4% |
Computer Science | 3 | 4% |
Nursing and Health Professions | 2 | 3% |
Other | 11 | 14% |
Unknown | 19 | 25% |