Natural history and outcome of inflammatory bowel diseases in children in Saudi Arabia: A single-center experience

Abstract

Background/Aim:Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder which includes ulcerative colitis (UC), Crohn's disease (CD), and indeterminate colitis (IC). The natural history of pediatric IBDs is poorly understood and generally unpredictable. We aim to study the natural history of IBD in Saudi children including the extraintestinal manifestations, changes in diagnosis, disease behavior, medical management, and surgical outcome.Patients and Methods:A retrospective review of all the charts of children less than 14 years of age who were diagnosed as IBD and followed up in King Faisal Specialist Hospital and Research Center (KFSH and RC) from January 2001 to December 2011 was performed.Results:Sixty-six children were diagnosed with IBD, 36 patients (54.5%) had CD, 27 patients (41%) had UC, and 3 patients (4.5%) had IC. Change in the diagnosis from UC to CD was made in 5 patients (7.6%). Extraintestinal manifestations were documented in 32% of all patients, and the most common was bone involvement (osteopenia/osteoporosis) in 16.7% of the patients. Arthritis (13.6%) was the second most common manifestation. Sclerosing cholangitis was reported in 2.8% in CD compared to 14.8% in UC. At the time of data collection, 8 patients (12%) were off therapy, 38 patients (57.6) were on 5-ASA, 31 patients (47%) were on azathioprine, and 12 patients (18.2%) were receiving anti-TNF. Of the children with CD, 10 patients (27.8%) underwent 1 or more major operations. Of the children with UC, 18.5% underwent 1 or more major intraabdominal procedures.Conclusions:Many issues in pediatric IBD can predict the natural history of the disease including growth failure, complications, need for more aggressive medical treatment, and/or surgery. More studies are needed from the region focusing on factors that may affect the natural history and disease progression.

Extraintestinal Manifestations of Inflammatory Bowel Disease in Middle Eastern Patients

“…However, only 5% of CD patients have dermatological manifestations, 15.5% have arthritis or arthralgia, and 2.3% have deep vein thrombosis (DVT) [ 20 ]. A study in Riyadh showed that 32% of pediatric IBD patients have EIMs, most of them have indeterminate colitis [ 21 ].…”

Extraintestinal manifestations of pediatric inflammatory bowel disease in Saudi Arabia

“…I presume that the differences in the reported prevalence and pattern of EIMs in the study by Alreheili et al . [ 1 ] and that reported in other Saudi studies[ 2 3 ] could be plausibly explained by a number of factors.…”

“…I refer to the interesting study by Alreheili et al . [ 1 ] published in this Journal. It is well-known that inflammatory bowel disease (IBD) is associated with a variety of extraintestinal manifestations (EIMs) that could produce greater morbidity than the underlying intestinal disease and might even be the initial presentation of IBD.…”

“…The authors mentioned that during the 10-year study period (2001–2011) in a single-center in the Kingdom of Saudi Arabia (KSA), EIMs were reported in 21 (31.8%) of 66 patients. [ 1 ] These included osteoporosis/osteopenia ( n = 11), peripheral joint inflammation ( n = 9), primary sclerosing cholangitis ( n = 5), erythema nodosum ( n = 2), sacroiliitis ( n = 2), ankylosing spondylitis ( n = 2), pyoderma gangrenosum ( n = 1), and uveitis/episcleritis ( n = 1). [ 1 ] Interestingly, this reported prevalence of EIMs appeared higher than that previously reported in KSA.…”

Prevalence of Classical Extraintestinal Manifestations among Inflammatory Bowel Disease Patients in Saudi Arabia: A Single Tertiary Center Experience

“…[ 11 ] A study conducted in Riyadh, Saudi Arabia, reported an even higher EIM prevalence among pediatric IBD patients (32%), the majority with indeterminate colitis. [ 12 ] In a South Korean study, frequent EIMs in IBD patients included rheumatoid arthritis, aphthous stomatitis, and osteoporosis. [ 13 ]…”