This was a retrospective cohort study aimed at identifying parameters measured at diagnosis of pediatric IBD to predict subsequent biologic therapy, as an equivalent to an unfavorable clinical course. Identification of predictors of poor outcomes is an important issue in current ECCO guidelines on pIBD. The study population consisted of 119 children with Crohn’s disease and 112 with ulcerative colitis, diagnosed and monitored for at least 1 year from 2009–2019. The population was divided into the study groups separately: 39 children with CD and 14 with UC who received biologics before the age of 18 y compared to 80 with CD and 98 with UC who did not. The combined analysis of 53 biologic therapy recipients vs. 178 non-recipients with IBD was also conducted. Logistic regression tests (OR, RR) and sensitivity, specificity, PPV, and NPV were used. Factors significantly correlated with subsequent biologic therapy were perianal disease, complicated disease behavior, high PCDAI (CD), fatigue, hypoalbuminemia, high PUCAI (UC) and fever, fatigue, hypoalbuminemia, hypoproteinemia, and elevated CRP (IBD). Marginally significant factors were ileocecal disease, elevated serum IgA, anemia, and L4a–L4b coexistence. Apart from parameters already accepted as POPO (B2/3, perianal disease), interesting observations are the significance of IgA, L4a–L4b in CD, and hypoalbuminemia in UC.

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.

The rising prevalence of inflammatory bowel disease (IBD) and food allergies and their partially overlapping mechanisms such as microbiome diversity reduction raise questions about the role of allergies in IBD. While data on their comorbidity are available, analysis of IgE-sensitization’s influence on the clinical presentation of IBD is lacking and is the aim of this study. Histories of 292 children with newly diagnosed IBD (173 cases of ulcerative colitis, 119 cases of Crohn’s disease) were analyzed. Disease age of onset, activity, location, behaviour, and anthropometric and laboratory parameters were tested for its dependence on the presence of chosen IgE sensitization markers. A.o. Chi2, OR and phi coefficient were assessed. In Crohn’s disease (CD), elevated total IgE (tIgE) correlated with weight loss, rectal bleeding, ASCA IgG positivity (φ = 0.19 for all) and negatively correlated with complicated disease behaviour (φ = −0.19). TIgE > 5 × reference range correlated with being underweight (φ = 0.2), ASCA IgG positivity (φ = 0.3), ASCA double (IgA and IgG) positivity (φ = 0.25) and elevated total IgG (φ = 0.18). The presence of specific IgEs (sIgE) correlated with extraintestinal manifestations of IBD (φ = 0.19): Egg white sIgE correlated with upper GI involvement (L4b) (φ = 0.26), severe growth impairment (φ = 0.23) and colonic mucosal eosinophilia (φ = 0.19). In ulcerative colitis, decreased IgA correlated with egg white sIgE (φ = 0.3), as well as the presence of any (φ = 0.25) or multiple sIgEs (φ = 0.2); the latter correlated also with elevated IgG (φ = 0.22), fever (φ = 0.18), abdominal pain (φ = 0.16) and being underweight (φ = 0.15). Cow’s milk sIgE correlated positively with growth impairment (φ = 0.15) and elevated IgG (φ = 0.17) and negatively with extensive colitis (φ = −0.15). Pancolitis correlated negatively with sIgE presence (φ = −0.15). In summary, single moderate and numerous weak but interesting relationships were observed.

Background Inflammatory bowel disease (IBD) and its major forms, i.e. Crohn’s disease (CD) and ulcerative colitis (UC), have systemic implications, which, as suggested by Vavricka et al., can be divided into extraintestinal manifestations (EIM) directly related to immune mechanisms and non-immune extraintestinal complications resulting from malabsorption. Extraintestinal manifestations may develop prior to or after IBD diagnosis. 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. Methods The medical records of 336 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. The diagnosis was made based on the revised Porto criteria. The medical histories of patients and data obtained in physical examinations were analysed, especially the following: (a) anthropometric measurements for nutritional status assessment based on percentile charts of the OLAF study, (b) disease activity using the PCDAI and the PUCAI, disease location and type according to the Paris classification. Results The study population of 336 children comprised 175 patients with UC and 161 patients with CD. EIMs were diagnosed in 65 patients (19%). 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 13,7% of UC patients. Arthropathy was the most prevalent EIM in the subpopulation of CD participants (8,6%). Pancolitis was a risk factor for EIMs in the UC and especially for PSC and AIH/PSC. We also analysed the population for correlation in presented symptoms pattern in patients EIM(+) vs. EIM(-) as well as differences in age and sex distribution and IBD activity, location and behaviour. Conclusion EIMs are a significant issue in the population of children with IBD; they developed in 19% 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.