Early IBD diagnosis & course of disease

July 22, 2020

Issue 14

Clinical Question

Do outcomes differ for patients diagnosed with IBD at a very young age?

Editor’s Bottom Line

Very early-onset IBD represents a distinct patient subgroup that is more refractory to medical therapy and more likely to require surgery.

Reference

Kelsen JR, Conrad MA, Dawany N, et al. The Unique Disease Course of Children with Very Early-onset Inflammatory Bowel Disease. Inflamm Bowel Dis. 2020;26(6):909–18; https://doi.org/10.1093/ibd/izz214

Synopsis

To compare the disease course of very early onset-IBD (VEO-IBD) to later-onset pediatric IBD, researchers at the Children’s Hospital of Philadelphia examined medical record data from 229 individuals diagnosed with IBD at six years of age or younger (median age at diagnosis: 3.9 years), 221 patients diagnosed between 6 and 10 years of age (median age: 8 years), and 521 diagnosed between 10 and 18 years of age (median age: 13.3 years). They compared disease phenotype and location, history of surgeries and hospitalizations, and medical treatment response. Patients had been seen at the health system between 2008 and 2015 and were followed for at least one year after diagnosis. Roughly 60% in each age group had Crohn’s disease (CD).

The authors found that those with very early onset CD were more likely to have strictly colonic disease at diagnosis (45.7% vs. 22.3% and 15.2% for VEO-IBD vs. 6–10 and 10–18 years old, respectively; P<0.0001). Additionally, those with VEO-IBD were more likely to have non-penetrating and non-stricturing disease (86.8% vs. 75.4% and 66.2% for VEO-IBD, 6–10 years and 10–18 years, respectively; P<0.05). Diverting ileostomies were more common among VEO-IBD patients (12.2% vs. 4.1% and 1.2%; P<0.01), as were rates of colectomies (7.4% vs. 1.7% for VEO-IBD and 10–18 years, respectively; P<0.001). While those in the older groups experienced significant improvements in median weight-for-age z scores during the study period, the authors found no improvements among those with VEO-IBD. Those with VEO-IBD had higher rates of non-response to biologic as well as immunosuppressive therapy at one year (62.4% vs. 14.6% for infliximab for VEO-IBD vs. 10–18 years; 53% vs. 7.2% for adalimumab; and 69.1% vs. 19.5% for immunomodulators; P<0.05 for all). Finally, patients with VEO-IBD had significantly longer hospital stays (average 31.6 days for VEO-IBD vs. 16 days for 10–18 years; P<0.05) and they were more likely to be readmitted to hospital (4 vs. 2.5 readmissions per patient for VEO-IBD and 10–18 years, respectively; P<0.01).

Details

Study Design: Retrospective cohort
Funding: The National Institutes of Health, the Ruth K. Broad Biomedical Research Foundation and the Keystone Symposia.
Allocation: Not applicable
Setting: Single-center database
Level of Evidence: 2b (Oxford Levels of Evidence)