Abstract
Objectives
To identify similarities and differences between the pediatric-onset and adult-onset Inflammatory Bowel Disease (IBD) based cohorts and further characterize the pediatric cohort.
Methods
A retrospective analysis of pediatric patients attending the tertiary referral care gastroenterology center from 2004 to 2016 was conducted. All the patients were clinically evaluated, investigated and followed up at the centre.
Results
Sixty five patients with pediatric IBD were compared with 216 patients with adult-onset IBD. The Ulcerative colitis: Crohn’s disease (UC:CD) ratio was higher in adult-onset population (2.29:1 vs. 1.7:1). Predominant symptoms in pediatric UC were diarrhea and passage of blood in stools; whereas those in pediatric CD were abdominal pain and failure to gain weight. Ulcerative proctitis was less common (2.4% vs. 18.8%; p = 0.009) and an extensive disease (pancolitis) was more common in the pediatric population (73.1% vs. 30.2%; p < 0.00001). Adult CD had higher L3 (33.3% vs. 46.1%; p = 0.28) disease; whereas in pediatric CD, L1 disease (37.5% vs. 32.3%; p = 0.65) was predominant. There was no difference with respect to penetrating and stricturing complications of CD in adults vs. children (20.8% vs. 23.1%; p = 0.974). 5-ASA agents were used more commonly in the pediatric IBD population (96.9% vs. 79.9%; p = 0.0034) as compared to adults whereas corticosteroids (87.5% vs. 76.9%; p = 0.28) and infliximab (25% vs. 9.2%; p = 0.054) were used more frequently in the pediatric CD subgroup as compared to adult CD subgroup.
Conclusions
IBD has significant disease heterogeneity according to the age of onset. Pediatric IBD has distinctive features that set it apart from adult-onset IBD.
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References
M’Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013;6:33–47.
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–94.
Auvin S, Molinie F, Gower-Rousseau C, et al. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988–1999). J Pediatr Gastroenterol Nutr. 2005;41:49–55.
Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis. 2008;14:S9–11.
Langholz E, Munkholm P, Krasilnikoff PA, Binder V. Inflammatory bowel diseases with onset in childhood (Clinical features, morbidity, and mortality in a regional cohort). Scand J Gastroenterol. 1997;32:139–47.
Sathiyasekaran M, Raju BB, Shivabalan S, Rajarajan K. Pediatric Crohn's disease in South India. Indian Pediatr. 2005;42:459-63.
Avinash B, Dutta AK, Chacko A. Pediatric inflammatory bowel disease in South India. Indian Pediatr. 2009;46:639–40.
Sathiyasekaran M, Bavanandam S, Sankaranarayanan S, et al. A questionnaire survey of pediatric inflammatory bowel disease in India. Indian J Gastroenterol. 2014;33:543-9.
Pigneur B, Seksik P, Viola S, et al. Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis. 2010;16:953-61.
Van Limbergen J, Russell RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008;135:1114–22.
Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut. 2005;54:1121–5.
Turunen P, Kolho KL, Auvinen A, Iltanen S, Huhtala H, Ashorn M. Incidence of inflammatory bowel disease in Finnish children, 1987–2003. Inflamm Bowel Dis. 2006;12:677–83.
Vind I, Riis L, Jess T, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database. Am J Gastroenterol. 2006;101:1274-82.
Ray G. Inflammatory bowel disease in India - past, present and future. World J Gastroenterol. 2016;22:8123-36.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–53.
Jakobsen C, Bartek J Jr, Wewer V, et al. Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease – a population-based study. Aliment Pharmacol Ther. 2011;34:1217-24.
de Bie CI, Paerregaard A, Kolacek S, Ruemmele FM, Koletzko S, Fell JM, et al. Disease phenotype at diagnosis in pediatric Crohn’s disease: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis. 2013;19:378–85.
Levine A, de Bie CI, Turner D, et al. Atypical disease phenotypes in pediatric ulcerative colitis: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis. 2013;19:370-7.
Lee HA, Suk JY, Choi SY, et al. Characteristics of pediatric inflammatory bowel disease in Korea: comparison with EUROKIDS data. Gut Liver. 2015;9:756-60.
Heyman MB, Kirschner BS, Gold BD, et al. Children with early onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr. 2005;146:35-40.
Ouyang Q, Tandon R, Goh KL, Ooi CJ, Ogata H, Fiocchi C. The emergence of inflammatory bowel disease in the Asian Pacific region. Curr Opin Gastroenterol. 2005;21:408–13.
Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther. 2002;16:51–60.
Sauer CG, Kugathasan S. Pediatric inflammatory bowel disease: highlighting pediatric differences in IBD. Med Clin North Am. 2010;94:35–52.
Mamula P, Markowitz JE, Baldassano RN. Inflammatory bowel disease in early childhood and adolescence: special considerations. Gastroenterol Clin N Am. 2003;32:967–95.
Gower-Rousseau C, Vasseur F, Fumery M, et al. Epidemiology of inflammatory bowel diseases: new insights from a French population-based registry (EPIMAD). Dig Liver Dis. 2013;45:89-94.
Guariso G, Gasparetto M, Visonà Dalla Pozza L, et al. Inflammatory bowel disease developing in paediatric and adult age. J Pediatr Gastroenterol Nutr. 2010;51:698-707.
Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification of inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011;17:1314-21.
Markowitz J, Grancher K, Kohn N, Lesser M, Daum F. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology. 2000;119:895–902.
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DNA is the consultant in-charge and is responsible for the clinical decisions and concept. ADS and PS gathered data and composed the manuscript. ADS will act as guarantor for this paper.
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Sonavane, A.D., Sonawane, P. & Amarapurkar, D.N. Inflammatory Bowel Disease Across the Age Continuum: Similarity and Disparity. Indian J Pediatr 85, 989–994 (2018). https://doi.org/10.1007/s12098-018-2665-5
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DOI: https://doi.org/10.1007/s12098-018-2665-5