I Objective: Pediatric Crohn’s disease has a more aggressive phenotype and course than in adults. Many patients develop complications that require surgery. The aim of this study was to identify the factors associated with increased risk for surgical intervention in pediatric patients with Crohn’s disease. Subjects and Methods: Retrospective review of medical records. We analyzed the following variables: sex, age at diagnosis, presenting symptoms, duration of symptoms before diagnosis, disease location and severity, presence of extraintestinal manifestations and presence of anti Saccharomyces cerevisiae antibodies. Univariate analysis using the Mann-Whitney test and the Fisher’s exact test was performed to detect the factors associated with surgery. Potential risk factors with p < 0.05 were further analyzed using a multivariate binary logistic regression model. Results: Fifty-seven patients (27 girls and 30 boys) were included in the analysis. More than one fourth of them (28.1%) required surgical management. Female sex (p = 0.043), disease behavior (p = 0.012) and presence of perianal disease at diagnosis (p < 0.001) were the variables associated with surgical intervention. Stricturing disease (OR, 24.944; p = 0.016), stricturing and penetrating disease (OR, 28.276; p = 0.011) and presence of perianal disease at diagnosis (OR, 95.802; p = 0.001) were independent risk factors for surgery. Female sex was associated with surgery without being an independent risk factor. Conclusion: Females with stricturing or stricturing and penetrating disease, or presence of perianal disease at diagnosis are at a higher risk for surgery and should be considered for more aggressive medical treatments.

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Inflammatory bowel disease (IBD) is a collective term that includes a group of disorders with unknown etiology characterized by chronic inflammation of the gastrointestinal tract and relapsing and remitting course. Ulcerative colitis (UC) is a type of IBD that affects the large intestine, causing irritation, inflammation, and ulcers in its lining. Approximately 25% of patients with IBD are diagnosed before the age of 18 years. Children and adolescents with UC are more likely to have more severe disease course with more extended intestinal involvement at diagnosis and faster disease progression than adults. Atypical presentation is also common in pediatric age. Treatment recommendations for children and adolescents are different than those for adults and offer many unique challenges for the healthcare professionals.

Anemia is the most common extraintestinal manifestation and complication of inflammatory bowel disease (IBD). The aim of our study was to assess the prevalence of anemia in newly diagnosed pediatric patients with IBD and to analyze its association with disease type, extent, and severity. We retrospectively reviewed the medical records of all patients with IBD treated in our department in the period of November 2011 to November 2020. The final analysis included the records of 80 children with newly diagnosed IBD: 45 with ulcerative colitis (UC) and 35 with Crohn’s disease (CD). The prevalence of anemia was 60.0% in the UC patients and 77.1% in the CD patients. Of the UC patients with anemia, 37.1% had pancolitis, 18.5% extensive disease, 33.3% left-sided colitis and 11.1% ulcerative proctitis. Of the CD patients with anemia, 81.5% had ileocolonic disease, 11.1% colonic disease and 7.4% ileal disease. Anemia was less common in patients with mild disease than in patients with moderate–severe disease (22.2 vs. 77.8%, p < 0.001 in UC and 25.9% vs. 74.1%, p < 0.001 in CD). Our study confirmed anemia as a frequent problem in pediatric patients with IBD. Children with more extensive and more severe disease are at higher risk to develop anemia.