Paediatric-onset IBD tied to more severe disease course
Patients with paediatric-onset inflammatory bowel disease (pIBD) have a higher incidence of severe IBD than those with adult-onset IBD (aIBD), according to a study presented at AIBD 2018.
This population-based study involved 333 pIBD patients (aged <15 years) and 446 aIBD patients (aged >18 years). The pIBD cohort comprised 166 patients diagnosed with Crohn’s disease (CD), 145 with ulcerative colitis (UC), and 22 with inflammatory bowel disease unclassified; while the aIBD cohort included 183 patients diagnosed with CD and 263 with UC. All health records were manually collected during their last follow-up. [AIBD 2018, abstract P078]
A significantly higher incidence of CD with upper gastrointestinal tract involvement was observed among pIBD patients compared with the aIBD patients (24 percent vs 9 percent; p<0.0001).
In addition, most of the pIBD patients with CD had a significantly higher rate of non-inflammatory behaviour than the aIBD patients with CD (48 percent vs 37 percent; p=0.04).
Among all patients with UC, a significantly higher rate of extensive disease at diagnosis was observed in the pIBD cohort than the aIBD cohort (66 percent vs 24 percent; p<0.0001).
Majority of the patients were treated with anti-tumour necrosis factor-alpha medications in the pIBD cohort at 42 percent than aIBD cohort at 14 percent.
At 7 years of follow-up, pIBD patients reported a significantly higher risk of relapse than the aIBD patients (incidence rate ratio, 1.8, 95 percent confidence interval [CI], 1.4–2.2; p<0.0001).
Bowel resection occurred more frequently in the pIBD cohort at 29 percent compared with the aIBD cohort at 18 percent (hazard ratio [HR], 1.4, 95 percent CI, 0.97–2.0 and HR, 0.9, 95 percent CI, 0.5–1.7 for all patients with CD and UC, respectively).
“Compared to previous results, this population-based cohort study demonstrated a clearly more severe disease course in pIBD than in aIBD,” said Dr Mikkel Malham from the Hvidovre University Hospital in Hvidovre, Denmark, who suggested that “pIBD patients must be monitored intensively and the top-down treatment protocol should be investigated for pIBD.”
“As a future consequence of the severe disease course and frequent use of immunosuppressive medicine, attention should be paid towards the possible increased cancer risk in these patients,” Malham added.