Inflammatory Bowel Disease Developing in Paediatric and Adult Age

Abstract

Background and Objective: In recent decades, there has been a significant increase in the incidence of inflammatory bowel disease (IBD). It has yet to be established whether the manifestations of IBD are similar in paediatric and adult ages. The objective of this study was to compare the phenotypic expression of the disease between patients with childhood‐onset IBD and adulthood‐onset cases, all afferent to the same clinical centre. Patients and Methods: Descriptive and multivariate analyses were completed on retrospective and prospective data of paediatric‐onset and adult‐onset consecutive cases who were diagnosed and followed at the same tertiary referral hospital of the University of Padua, Italy, during a period of 14 years (1994–2008). Paediatric‐onset patients were further divided into age brackets (0–5, 6–12, and 13–17 year‐olds). Analyses were conducted using the SAS package, version 9.1 (SAS Institute Inc, Cary, NC). Results: Three hundred twelve patients were analysed. At disease onset, the manifestations which were more frequent among the 133 paediatric patients (50.4% with diagnosis of Crohn disease [CD], 43.6% with ulcerative colitis, and 6% with unclassified IBD) with respect to the adult‐onset patients were perianal disease (12.8%) (P < 0.0001) and extraintestinal manifestations (14.3%) (P = 0.043). Among the 179 adult patients (55.3% with diagnosis of ulcerative colitis, 36.3% with CD, and 8.3% with unclassified IBD) instead, severe abdominal pain (P = 0.008), diarrhoea (P = 0.005), and anorexia (P < 0.0001) were more frequently observed. During the follow‐up, the presence of extraintestinal manifestations (50.4%) (P = 0.005) and perianal disease (44.8% of the patients with childhood‐onset CD) (P = 0.006) was observed more often in the paediatric‐onset group. Conclusions: In our cases, the phenotypic expression of IBD developing in paediatric age differs from that seen in adults.

ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

“…IBD should be suspected when patients appear with the appropriate symptoms, which may be extremely diverse (10)(11)(12)(13). Bloody diarrhea is the most common presenting symptom in UC whereas CD may present with vague abdominal pain, diarrhea, unexplained anemia, fever, weight loss, or growth retardation as frequently reported symptoms.…”

Inflammatory bowel diseases: from pathogenesis to laboratory testing

“…While the incidence of IBDs in western Europe has progressively increased since the World War II, apparently plateauing and now affecting 0.5%-1.0% of the population, it is on the increase in areas with a low incidence (eastern and southern Europe, the Middle East, Asia, Latin America and Indian subcontinent). IBDs have higher morbidity and mortality rates than most other diseases, and incur an important risk of complications (in children 29% at diagnosis and 59% at follow-up; in adults 16% after diagnosis) [2]. Currently, pediatric IBDs are considered a distinct disease rather than simply a particularly severe and early presentation of a common form of IBDs evolving from pediatric to adult age.…”

“…Although the two main IBDs clinical subtypes, UC and CD, have distinct clinical and pathological features, IBDs remain unclassified in about 6% of pediatric and 8% of adult onset cases [2]. Serum markers of clinical utility in diagnosing IBDs and aiding the differentiation between CD and UC are: 1) IgA and IgG class antibodies anti-Saccharomyces cerevisiae (ASCA), which can be determined by means of enzyme immunoassays; and 2) IgG class antineutrophil cytoplasmic antibodies (ANCA) demonstrating atypical perinuclear staining (pANCA), which can be assessed by indirect fluorescent antibody assays.…”

“…Inflammatory bowel diseases (IBDs) comprise a heterogeneous group of chronic inflammatory disorders of the intestinal tract, most cases having an onset during young adulthood, although about 20%-25% of patients are diagnosed during childhood [1][2][3]. Unlike adult IBDs, pediatric IBDs have a particularly severe clinical activity, and are predominant in males, the most frequent clinical presentation being ileocolonic inflammation in cases of Crohn's disease (CD) and pan-colitis in ulcerative colitis (UC), the two major clinical subtypes.…”

Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion

“…[5][6][7] In addition, perianal lesions at presentation are more common in children than in adults. 8 Due to their heterogeneous appearance, perianal lesions of Crohn's disease can be mistaken for benign lesions. Nonpathologic perianal skin tags are common and are estimated to occur in 5% to 11% of healthy children.…”