Definition of Phenotypic Characteristics of Childhood-Onset Inflammatory Bowel Disease

Johan Van Limbergent, Richard K. Russell, Hazel E. Drummond, Marian C. Aldhous, Nicola K. Round, Elaine R. Nimmo, Linda Smith, Peter M. Gillett, Paraic McGrogan, Lawrence T. Weaver, W. Michael Bisset, Gamal Mahdi, Ian D. Arnott, Jack Satsangi, David Wilson

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Childhood-onset inflammatory bowel disease (IBD) might be etiologically different from adult-onset IBD. We analyzed disease phenotypes and progression of childhood-onset disease and compared them with characteristics of adult-onset disease in patients in Scotland. Methods: Anatomic locations and behaviors were assessed in 416 patients with childhood-onset (276 Crohn's disease [CD], 99 ulcerative colitis [UC], 41 IBD type unclassified [IBDU] diagnosed before seventeenth birthday) and 1297 patients with adult-onset (596 CD, 701 UC) IBD using the Montreal classification. Results: At the time of diagnosis in children, CD involved small bowel and colon (L3) in 51% (138/273), colon (L2) in 36%, and ileum (M) in 6%; the upper gastrointestinal (GI) tract (L4) was also affected in 51%. In 39%, the anatomic extent increased within 2 years. Behavioral characteristics progressed; 24% of children developed stricturing or penetrating complications within 4 years (vs 9% at diagnosis; P < .0001; odds ratio [OR], 3.32; 95% confidence interval [CI], 1.86 - 5.92). Compared with adults, childhood-onset disease was characterized by a "panenteric" phenotype (ileocolonic plus upper GI [L3 + L4]; 43% vs 3%; P <. 0001; OR, 23.36; 95% CI, 13.45 - 40.59) with less isolated ileal (L1; 2% vs 31%; P < .0001; OR, 0.06; 95% CI, 0.03 - 0.12) or colonic disease (L2; 15% vs 36%; P < .0001; OR, 0.31; 95% CI, 0.21 - 0.46). UC was extensive in 82% of the children at diagnosis, versus 48% of adults (P < .0001; OR, 5.08; 95% CI, 2.73 - 9.45); 46% of the children progressed to develop extensive colitis during follow-up. Forty-six percent of children with CD and 35% with UC required immunomodulatory therapy within 12 months of diagnosis. The median time to first surgery was longer in childhood-onset than adult-onset patients with CD (13.7 vs 7.8 years; P < .001); the reverse was true for UC. Conclusions: Childhood-onset IBD is characterized by extensive intestinal involvement and rapid early progression.

Original languageEnglish
Pages (from-to)1114-1122
Number of pages9
JournalGastroenterology
Volume135
Issue number4
DOIs
Publication statusPublished - Oct 2008

Keywords

  • Adolescent
  • Adult
  • Age of Onset
  • Child
  • Colitis, Ulcerative
  • Crohn Disease
  • Digestive System Surgical Procedures
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Immunologic Factors/therapeutic use
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Phenotype
  • Prevalence
  • Scotland/epidemiology

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