Presentation and Disease Course in Early- Compared to Later-Onset Pediatric Crohn's Disease

Abstract

BACKGROUND The relationship between the age at diagnosis and disease course is poorly defined in children with Crohn’s disease (CD). We examined the presentation and course of disease in patients 0–5 compared to 6–17 yr of age at diagnosis. METHODS We analyzed uniform data from 989 consecutive CD patients collected between January 2000 and November 2003, and stored in the Pediatric IBD Consortium Registry. The statistical tests account for the length of follow-up of each patient. RESULTS In total, 98 patients (9.9%) were of 0–5 yr of age at diagnosis. The mean follow-up time was 5.6 ± 5.0 yr in the younger group and 3.3 ± 2.8 yr in the older group (P < 0.001). Race/ethnicity differed by the age group (P = 0.015); a larger proportion of the younger group was Asian/Pacific Islander or Hispanic, and a larger proportion of the older group was African American. The initial classification as ulcerative colitis or indeterminate colitis was more common among the 0–5 yr of age group (P < 0.001). The 6–17 yr of age patients presented with more abdominal pain (P < 0.001), weight loss (P = 0.001), or fever (P = 0.07), while the 0–5 yr of age patients presented with more rectal bleeding (P = 0.008). The 6–17 yr of age patients were more likely to be treated with antibiotics (P < 0.001), 6-mercaptopurine/azathioprine (P < 0.001), infliximab (P = 0.001), or corticosteroids (P = 0.0006). The 6–17 yr of age patients had a higher cumulative incidence of treatment with 5-aminosalicylates (P = 0.009) or methotrexate (P = 0.04). The risk for developing an abscess (P = 0.001), a fistula (P = 0.02), a stricture (P = 0.05), or a perianal fissure (P = 0.06) was greater in the 6–17 yr of age patients. CONCLUSIONS The 6–17 yr of age patients with CD appear to have a more complicated disease course compared to 0–5 yr of age children. The 0–5 yr of age group may represent a unique disease phenotype and benefit from different approaches to management. Long-term prospective studies are required to validate these findings.

Incidence and Phenotype at Diagnosis of Very-early-onset Compared with Later-onset Paediatric Inflammatory Bowel Disease: A Population-based Study [1988–2011]

“…As previously reported, 7,14,15,17,29,35 the initial presentation was different according to age group, with mucous bloody stools significantly more frequent in cases of VEO-IBD, probably because of the higher rate of isolated colonic disease in those with CD and a higher proportion of UC compared with older children. As noted by Gupta et al, 17 weight loss and abdominal pain were significantly more common in the EO-IBD group and this was also the case in our study. This was likely linked to a higher proportion of CD in this age group and the difficulties in expressing abdominal pain among very young children.…”

“…This was likely linked to a higher proportion of CD in this age group and the difficulties in expressing abdominal pain among very young children. Gupta et al 17 also reported that the rates of EIMs at diagnosis of IBD were similar in both age groups. In those with CD, the rate of complicated behaviours [B2 or B3] was similar in both age groups in our study, which contrasts with Gupta et al's finding of a higher rate of complicated behaviours in those with IBD aged 6-16 years/ 17 Upper gastrointestinal location [L4] and anoperineal lesions were found to be similar in both age groups.…”

“…The cut-off of 6 years was chosen based on previous studies. 7,14,15,17 The EPIMAD Registry is a prospective population-based study recording all cases of IBD documented since 1988 in Northern France [ Figure 1]. This study area includes 5 864 508 inhabitants, representing 9.3% of the total French population, and is divided into four administrative areas.…”

“…The phenotype of children with VEO-IBD is loosely defined but is usually considered as being more severe than when diagnosed later in life. [17][18] However, most published studies have not been population based but covered patients followed in referral centres, and the incidence and natural history of VEO-IBD are still poorly understood.…”

Carcinoma of colon: A rare cause of fever of unknown origin

“…Therefore, it is reasonable to suggest that clinicians should seriously consider performing colonoscopy in patients with FUO, undiagnosed after a conventional work-up including abdominal CT scan. Colonoscopy is an essential investigation because both colon cancer and Crohn's disease are classic causes of recurrent FUO [14,15] . Colonoscopy definitely has a better yield than barium enema as the small sizes of tumor might be missed and it has the added advantage of providing tissue confirmation [16] In summary, we have described 2 patients who had fever for years: the first unequivocally related to carcinoma of the colon and the second likely to be causally related.…”