Extraintestinal Manifestations Are Associated With Disease Severity in Pediatric Onset Inflammatory Bowel Disease

Jansson, Sabine; Malham, Mikkel; Pærregaard, Anders; Jakobsen, Christian; Wewer, Vibeke

doi:10.1097/mpg.0000000000002707

Cited by 17 publications

(13 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, EIMs at diagnosis have been also associated with a more severe course over time [ 17 ]. Similar results have been reported for pediatric-onset CD [ 18 ], suggesting that EIMs in children may have a worse prognosis than in adults and predict a more progressive disease course [ 15 , 19 , 20 ]. Aside from the younger age, the extension of disease and the degree of intestinal inflammation also seem to be associated with the risk of development of one or more EIMs [ 21 , 22 ].…”

Section: Extraintestinal Manifestations Of Ibdssupporting

confidence: 80%

Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases

Cucinotta

Romano

Dipasquale

2021

Genes

View full text Add to dashboard Cite

Inflammatory bowel diseases (IBDs) are chronic relapsing inflammatory conditions of the gastrointestinal tract, encompassing Crohn’s disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U). They are currently considered as systemic disorders determined by a set of genetic predispositions, individual susceptibility and environmental triggers, potentially able to involve other organs and systems than the gastrointestinal tract. A large number of patients experiences one or more extraintestinal manifestations (EIMs), whose sites affected are mostly represented by the joints, skin, bones, liver, eyes, and pancreas. Pancreatic abnormalities are not uncommon and are often underestimated, encompassing acute and chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency and asymptomatic elevation of pancreatic enzymes. In most cases they are the result of environmental triggers. However, several genetic polymorphisms may play a role as precipitating factors or contributing to a more severe course. The aim of this paper is to provide an updated overview on the available evidence concerning the etiology, pathogenesis and clinical presentation of pancreatic diseases in IBD pediatric patients.

show abstract

Section: Extraintestinal Manifestations Of Ibdssupporting

confidence: 80%

Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases

Cucinotta

Romano

Dipasquale

2021

Genes

View full text Add to dashboard Cite

show abstract

“…In most patients, no extraintestinal manifestations (EIMs) were reported during treatment with biological agents (∼25% of patients receiving a TNF-α blocker had EIMs after initiation). This number is higher than that reported in other studies where the rate of all EIMs in patients with IBD was approximately 14% ( 46 ). The explanation for these results may be the longer follow-up of our patient cohort, as some of the patients were investigated almost 5 years after the initial entry in the registry.…”

Section: Discussioncontrasting

confidence: 66%

Significant advantages for first line treatment with TNF-alpha inhibitors in pediatric patients with inflammatory bowel disease – Data from the multicenter CEDATA-GPGE registry study

et al. 2022

View full text Add to dashboard Cite

Background and aimsIn recent years, biological agents, such as anti-TNF-α blockers, have been introduced and have shown efficacy in pediatric patients with inflammatory bowel disease (IBD). Here, the prescription mode differentiated into a first/second line application, and efficacy and side effects are evaluated beginning from 2004 until today.MethodsStatistical analyses of the prospective and ongoing CEDATA multicenter registry data from the Society of Pediatric Gastroenterology and Nutrition (GPGE) were performed for patients receiving a biological agent at least once during the period from June 2004 until November 2020 (n = 487). The analyzed parameters were patient demographics, disease extent and behavior, prior or concurrent therapies, duration and outcome of biological therapy, disease-associated complications, drug-related complications, laboratory parameters and treatment response as determined by the Physician’s Global Assessment.ResultsCrohn’s disease (CD) was present in 71.5% of patients, and 52% were boys. Patients showed high disease activity when receiving a first-line TNF-α blocker. After 2016, patients who failed to respond to anti-TNF-α induction therapy were treated with off-label biologics (vedolizumab 4.3% and ustekinumab 2.1%). Propensity score matching indicated that patients with CD and higher disease activity benefitted significantly more from early anti-TNF-α therapy. This assessment was based on a clinical evaluation and lab parameters related to inflammation compared to delayed second-line treatment. Additionally, first-line treatment resulted in less treatment failure and fewer extraintestinal manifestations during TNF-α blockade.ConclusionFirst-line treatment with anti-TNF-α drugs is effective and safe. An earlier start significantly reduces the risk of treatment failure and is associated with fewer extraintestinal manifestations during longitudinal follow-up.

show abstract

“…More recently, Jansson et al 19 reported that EIMs are associated with future disease severity in pediatric IBD, finding that EIMs in UC increased the risk of biological treatment and surgery, and EIMs in CD increased the relapse rate. These results support those in studies done with French and Swiss pediatric IBD patients.…”

Section: Discussionmentioning

confidence: 99%

Severe Disease Activity Based on the Paris Classification Is Associated with the Development of Extraintestinal Manifestations in Korean Children and Adolescents with Ulcerative Colitis

et al. 2021

View full text Add to dashboard Cite

Background There are limited data regarding the extraintestinal manifestations (EIMs) associated with pediatric inflammatory bowel disease (IBD) in Korea. We aimed to investigate the clinical features and factors associated with the development of EIMs in Korean children and adolescents with IBD. Methods This multicenter, retrospective study was conducted from 2010 to 2017. Baseline clinicodemographic, laboratory findings, disease activity, disease phenotypes, and EIMs were investigated. Results A total of 172 patients were included. One-hundred thirty-seven (79.7%) had Crohn's disease (CD), and 35 (20.3%) had ulcerative colitis (UC). EIMs occurred in 42 patients (24.4%). EIMs developed in 34/137 diagnosed with CD (24.8%), and in 8/35 diagnosed with UC (22.9%), during a median follow-up duration of 3.2 (interquartile range, 1.9–5.4) years for CD and 3.0 (1.0–4.0) years for UC, respectively. Arthritis/arthralgia was most commonly observed (n = 15, 35.7%), followed by stomatitis/oral ulcer (n = 10, 23.8%), hepatitis (n = 5, 11.9%), nephritis (n = 4, 9.5%), pancreatitis (n = 2, 4.8%), erythema nodosum (n = 2, 4.8%), pyoderma gangrenosum (n = 1, 2.4%), primary sclerosing cholangitis (n = 1, 2.4%), uveitis (n = 1, 2.4%), and ankylosing spondylitis (n = 1, 2.4%). A significant difference in disease severity based on the Paris classification ( P = 0.011) and ESR at diagnosis ( P = 0.043) was observed between the EIM positive and negative group in patients with UC. According to logistic regression analyses, S1 disease severity based on the Paris classification was the only factor that was significantly associated with the development of EIMs (odds ratio, 16.57; 95% confidence interval, 2.18–287.39; P = 0.017). Conclusion Severe disease activity based on the Paris classification in pediatric patients with UC was significantly associated with EIM development. As disease severity in the Paris classification is a dynamic parameter, treatment should be focused on disease control to minimize the occurrence of EIMs in Korean children and adolescents with UC.

show abstract

Extraintestinal Manifestations Are Associated With Disease Severity in Pediatric Onset Inflammatory Bowel Disease

Cited by 17 publications

References 40 publications

Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases

Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases

Significant advantages for first line treatment with TNF-alpha inhibitors in pediatric patients with inflammatory bowel disease – Data from the multicenter CEDATA-GPGE registry study

Severe Disease Activity Based on the Paris Classification Is Associated with the Development of Extraintestinal Manifestations in Korean Children and Adolescents with Ulcerative Colitis

Contact Info

Product

Resources

About