The natural course of inflammatory bowel disease-indeterminate from childhood to adulthood: within a 25 year period

Abstract

BackgroundInflammatory bowel disease (IBD)-indeterminate is a subgroup of IBD that has features of both ulcerative colitis (UC) and Crohn’s disease (CD).AimsTo determine the clinical course of IBD-indeterminate in children over a 25 year period.MethodsWe performed a retrospective investigation on children diagnosed with IBD. Diagnosis and disease distribution of IBD was based on clinical, radiologic, endoscopic, and histologic examinations.ResultsFour hundred and twenty children diagnosed with IBD between 1986 and 2003 were identified from the IBD registry, 78 (22%) of whom were diagnosed with IBD-indeterminate. The mean age at diagnosis was 9.2 ± 4 years and the mean follow-up period was 4.1 ± 2 years. In 2003, 18 of 78 children (23%) were reclassified by the same physician based on the endoscopic and pathologic findings as follows: eight children with CD, five children with UC, and five children with non-IBD (eg, eosinophilic colitis). During 2011, 20 of the 60 patients who had maintained an IBD-indeterminate diagnosis were located and contacted, and detailed telephone interviews were conducted by the corresponding author. Two patients were reclassified as having CD (10%), one patient was reclassified as having eosinophilic colitis (5%), six patients remained with IBD-indeterminate (30%), and eleven patients (55%) reported a complete resolution of their symptoms. The follow-up period ranged from 10–18 years (mean 12.5 ± 3 years). Children who were reclassified as having CD were significantly younger than those who maintained an IBD-indeterminate diagnosis (6.4 ± 4 years versus11.2 ± 3 years, respectively, P = 0.05).ConclusionChildren with IBD-indeterminate remain classified as IBD-indeterminate, or were clinically reclassified as CD or non-IBD, or became asymptomatic as they transitioned into adulthood. The need for IBD-indeterminate classification is of importance, especially when deciding on management and treatment.

Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients

“…In other studies, 23-84% of patients with an initial diagnosis of IBD-U were later classified as UC or CD [9,12,24,[31][32][33]55]. In pediatric patients, a systematic review found an increase in diagnosis of CD over time, and a decrease in IBD-U [7].…”

“…The frequency of IBD-U is usually reported to be higher among pediatric patients compared to that of the adult population: 13 versus 6% in a meta-analysis [6], and to be decreasing over disease course [7]. In well characterized IBD cohorts, the proportion of IBD-U has been reported to range from 1 to 20% in adults [8][9][10][11][12][13][14][15][16][17][18][19][20] and from 4 to 22% in pediatric patients [21][22][23][24][25][26][27][28][29][30][31][32][33]) (Table 1).…”

The emerging global epidemic of paediatric inflammatory bowel disease – causes and consequences

“…Conversely, several endoscopic and microscopic CD manifestations exclude UC as a possible differential diagnosis. This explains why most follow‐up studies report that a significant proportion of patients with UC (or inflammatory bowel disease unclassified (IBDU)) will ultimately be re‐classified as having CD . It is probable that more frequent use of upper endoscopy, small bowel imaging and biopsy sampling in patients with adult‐onset IBD would increase the proportion diagnosed with CD rather than UC.…”

Juvenile Behсet's Disease: Clinical Observation

“…В европейском согласительном документе [3] под-черкнуто, что у пациентов, у которых есть клинические признаки воспалительного заболевания, но нет четких макро-и/или микроскопических признаков язвенно-го колита или болезни Крона, может использовать-ся термин «воспалительное заболевание кишечника неклассифицированное» (Inflammatory bowel disease unclassified, IBD-U). Ряд исследователей склонны счи-тать, что вариант IBD-U является отдельным фенотипом заболевания с особенностями клинической манифеста-ции симптомов в возрастном аспекте [6] распростра-ненности патологического процесса в кишечнике [7], длительного (годами) сохранения фенотипа [8] и более неблагоприятного прог ноза [9].…”

“…В биохимическом анализе сыворотки крови име-лась диспротеинемия: альбумин 48,98% (норма 53,0-68,0), альфа-1 глобулин -6,26% (норма 1,6-4,5), аль-фа-2 -23,01% (норма 5,7-11,5), бета -12,05% (норма 8,0-14,2), гамма -9,70% (норма 10, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]5).…”