Appraisal of the PIBD-classes Criteria: A Multicentre Validation

Ledder, Oren; Sonnino, Micol; Birimberg-Schwartz, Liron; Escher, Johanna C.; Russell, Richard K.; Orlanski-Meyer, Esther; Matar, Michael A.; Assa, Amit; Tzion, Raffi Lev; Shteyer, Eyal; Griffiths, Anne M.; Turner, Dan

doi:10.1093/ecco-jcc/jjaa103

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…Finally, the diagnosis of L2 CD was based on physician's assessment, and it is possible that some patients that were identified as having isolated colonic CD in fact exhibit ileo‐colonic CD, atypical UC or IBD‐U. We were unable to follow the PIBD classes criteria developed by Birimberg‐Schwartz et al (31) (and its modified version by Ledder et al (32)) in order to accurately classify paediatric patients into different IBD phenotype (including colonic CD vs UC vs atypical UC vs IBD‐U). These criteria are based on 19 items divided into three tiers, and require detailed phenotyping of each patient, including clinical, endoscopic, histologic and imaging data.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease

Berger

Lee

Padmanaban

et al. 2021

J. pediatr. gastroenterol. nutr.

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Background and aims: Ulcerative proctitis (UP) is an uncommon presentation in pediatric patients with ulcerative colitis. We aimed to characterize the clinical features and natural history of UP in children, and to identify predictors of poor outcomes. Methods:The retrospective cohort study involved 37 sites affiliated with the IBD Interest group of ESPGHAN. Data were collected at different time points from patients aged<18 years diagnosed with UP between 01/01/2016-31/12/2020. Results:We identified 250 patients with UP with a median follow-up of 2.7 (IQR 1.7-3.9) years. were included. Median age at diagnosis was 14.5 (IQR 12.3-15.9) years. Median follow-up was 2.7 (IQR 1.7-3.9) years. The most common presenting symptoms were bloody stools (93.6%), abdominal pain (60.4%) and diarrhea (52.8%). At diagnosis, the median pediatric ulcerative colitis activity index (PUCAI) score was 25 (IQR 20-35), the median fecal calprotectin level was 720 mcg/g (IQR 310-1800), notably 16 patients (11.7%) had a calprotectin level <100mcg/g. Most patients exhibited moderate-severe endoscopic inflammation. Oral, topical or By the end of induction, administration of orally, topically or combination of both resulted in clinical remission rates of 51.8%, 50.0% 73.3%, respectively at weeks 8-12?. The rates of treatment escalation to biologics at 1, 3 and 5 years were 10.6%, 22.7% and 44.6%. in multivariate analysis, Tthe PUCAI score at diagnosis was highly associated with escalation of therapy and subsequent events with acute severe colitis eventsand or IBD-associated admissions (multivariate analysis). By the end of follow-up, 3.4% of patients underwent colectomy. Cecal patch (P=0.009), higher PUCAI score (P=0.009) and lack of steroid-free clinical remission (P=0.005) by the end of induction were associated with proximal disease extension, identified in 48.3%.. Conclusion:Pediatric patients with UP exhibit high rates of proximal disease extension and treatment escalation.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease

Berger

Lee

Padmanaban

et al. 2021

J. pediatr. gastroenterol. nutr.

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“…A recently genetic association study and systematic review of the epidemiology, serology, and microbiology of IBD has shown that isolated colonic CD could be an intermediate between ileal CD and UC [ 21 22 ]. The Pediatric IBD Porto group have developed new criteria, the “PIBD-Classes,” to differentiate pediatric IBD into five categories to standardize the classification of subtypes—typical UC, atypical UC, IBDU, colonic CD, and CD [ 23 24 25 ]. Evaluation of the entire gastrointestinal tract has become more important, and recent advances in imaging studies and endoscopic devices can help clinicians in examining the small intestine [ 26 27 28 ].…”

Section: Discussionmentioning

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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“…As the disease progresses, some of these IBDunclassified cases later develop into either CD or UC. 13 In a small proportion of children, IBD (especially UC) coexists with primary sclerosing cholangitis (PSC-IBD). The distribution of inflammation in the lower GI tract is so typical that PSC-IBD is often considered as a separate phenotype, with relatively mild intestinal symptoms, most active inflammation in the proximal colon, rectal sparing, and backwash ileitis.…”

Section: Pediatric Inflammatory Bowel Diseasementioning

confidence: 99%

Pediatric Inflammatory Bowel Disease

Bouhuys¹,

Lexmond²,

Rheenen³

2022

Pediatrics

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Inflammatory bowel diseases (IBDs) are chronic, immune-mediated disorders that include Crohn’s disease and ulcerative colitis. A pediatric onset of disease occurs in about 10% of all cases. Clinical presentation of IBD with rectal bleeding or perianal disease warrants direct referral for endoscopic evaluation. In the absence of red-flag symptoms, a combination of patient history and blood and fecal biomarkers can help to distinguish suspected IBD from other causes of abdominal pain or diarrhea. The therapeutic management of pediatric IBD has evolved by taking into account predictors of poor outcome, which justifies the upfront use of anti-tumor necrosis factor therapy for patients at high risk for complicated disease. In treating patients with IBD, biochemical or endoscopic remission, rather than clinical remission, is the therapeutic goal because intestinal inflammation often persists despite resolution of abdominal symptoms. Pediatric IBD comes with unique additional challenges, such as growth impairment, pubertal delay, the psychology of adolescence, and development of body image. Even after remission has been achieved, many patients with IBD continue to experience nonspecific symptoms like abdominal pain and fatigue. Transfer to adult care is a well-recognized risk for disease relapse, which highlights patient vulnerability and the need for a transition program that is continued by the adult-oriented IBD team. The general pediatrician is an invaluable link in integrating these challenges in the clinical care of patients with IBD and optimizing their outcomes. This state-of-the-art review aims to provide general pediatricians with an update on pediatric IBD to facilitate interactions with pediatric gastrointestinal specialists.

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Appraisal of the PIBD-classes Criteria: A Multicentre Validation

Cited by 11 publications

References 13 publications

Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease

Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease

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

Pediatric Inflammatory Bowel Disease

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