Treatment Options and Outcomes of Pediatric IBDU Compared with Other IBD Subtypes

Self Cite

349

356

Section: Biologicsmentioning

confidence: 99%

Management of Paediatric Ulcerative Colitis, Part 1

Turner

Ruemmele

Orlanski-Meyer

et al. 2018

Self Cite

349

356

“…A recent study based on the EUROKIDS registry of newly diagnosed UC reported that 10% of 296 patients with pancolitis had endoscopic evidence of ''backwash ileitis''; however, histologic confirmation was not reported (27). In a subsequent article from the ESPGHAN Porto group, patients with ileitis were included in a cohort of ''indeterminate colitis'' patients, yet the management and outcomes were similar to patients with UC, with lower rates of surgery and good response to aminosalicylates (28).…”

Section: Discussionmentioning

confidence: 99%

Microscopic/“Backwash” Ileitis and Its Association With Colonic Disease in New Onset Pediatric Ulcerative Colitis

Najarían

Ashworth

Wang

et al. 2019

Background: Microscopic ileitis and its association with pancolitis in adults with ulcerative colitis (UC) have been described. The incidence of ileitis and associations with colonic disease in pediatric UC have, however, not been thoroughly investigated. This study was undertaken to examine the prevalence of microscopic ileal inflammation at the time of initial diagnosis in a cohort of children with UC. Methods: We reviewed colonoscopy and biopsy data at time of diagnosis from 105 children and young adults with treatment naïve UC; ileal and colonic mucosal biopsies were available on all patients. Ileal mucosal biopsies were examined for the presence and severity of ileal inflammation, and other histologic features. Concurrently obtained colonic mucosal biopsies were assessed to define the severity, distribution, and extent of disease; endoscopic and clinical follow-up data were reviewed. Results: A total of 107 ileal mucosal biopsies and 693 corresponding colonic mucosal biopsies were examined. Seventeen of 105 patients (16%) were found to have ileal inflammation (mean age = 10.4 years, 59% girls), 14 (82%) of whom had histologic pancolitis. The presence of ileal inflammation was significantly associated with endoscopic pancolitis (P = 0.02). The association between histologic pancolitis, severity of active inflammation in the cecum, and ascending colon suggested a possible association with ileal inflammation (P = 0.06, 0.07, and 0.08 respectively), but did not reach statistical significance. Conclusion: Patients with new onset UC may have microscopic ileal inflammation at time of diagnosis, even if the terminal ileum appears macroscopically normal. The presence of endoscopic pancolitis is associated with the presence of histologic ileitis. In contrast to existing studies in adults, an association between the presence of ileitis and the histologic severity or the histologic extent of colitis was not observed. Children with microscopic ileitis in the context of UC do not need to be reclassified as “indeterminate colitis” or Crohn disease.

“…In both CD and UC, the phenotype at end of follow-up was defined as the most severe phenotype found in the observation period and the phenotype at end of follow-up was used for comparisons, unless noted otherwise. As only a few IBDU patients (n ¼ 14) were included and IBDU previously was found to have a different disease course than CD and possibly also UC, IBDU patients were only included in the prevalence of EIM, but were excluded from further analysis (24).…”

Section: Phenotypementioning

confidence: 99%

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

Jansson¹,

Malham²,

Pærregaard³

et al. 2020

Objectives: The aim of this study was to investigate a possible association between extraintestinal manifestations (EIM) and a more severe disease course in pediatric onset inflammatory bowel disease (pIBD). Methods: This study compares the disease course of pIBD patients (IBD diagnosis <15 years of age) with and without EIM in a population-based cohort from Denmark. Patients diagnosed with pIBD between 1998 and 2008 were included in the study and followed until December 31, 2014. Data on phenotype, treatment, relapses, and the temporal relationship between IBD relapses and activity of EIM were collected at end of follow-up by manual revision of patient charts. Results: Of 333 pIBD patients, 14 (4.2%) had EIM at time of diagnosis and 47 (14.1%) developed EIM during follow-up. Median follow-up time was 9.6 years for patients with EIM and 8.8 years for patients without. In ulcerative colitis, EIM were associated with an increased risk of biological treatment and surgery (hazard ratio: 2.6; 95% confidence interval [CI]: 1.3–5.5, P = 0.008 and 2.9 [95% CI: 1.1–7.7, P = 0.03], respectively). In Crohn disease, EIM were associated with an increased relapse rate (1.3 [95% CI: 1.1–1.5], P = 0.001). Lastly, we found a positive temporal relationship between relapse of IBD and EIM activity. Conclusion: The presence of EIM is associated with a more severe disease course in pIBD. This should be considered when deciding treatment options, as a more aggressive treatment approach could be warranted in patients with EIM. However, prospective studies are needed to fully evaluate this.