title: Natural history of paediatric inflammatory bowel diseases over a 5-year follow-up: a retrospective review of data from the register of paediatric inflammatory bowel diseases.
abstract: OBJECTIVE
  The natural history of paediatric inflammatory bowel diseases (IBDs) is poorly understood. We aim to describe the disease course in this cohort and generate prognostic information for patients and clinicians.
  
  
  METHODS
  Patient records from 6 tertiary paediatric gastroenterology centres were reviewed to generate data concerning original diagnosis, change in diagnosis, family history, surgical interventions, growth, and presence of extragastrointestinal manifestations.
  
  
  RESULTS
  Data were collected on 116 children with Crohn disease (CD), 74 with ulcerative colitis (UC), and 20 with indeterminate colitis (IC), followed for a mean period of 3.42, 3.3, and 2.9 years from date of diagnosis, respectively. A male predominance is demonstrated in CD. Revision of diagnosis in patients with IC is mainly to UC, with most children receiving a definitive diagnosis within 2 years of initial presentation. Of the children with UC, 17.6% underwent 1 or more major operations with a median time to surgery of 1.92 years. Of children with CD, 11.6% underwent 1 or more major intraabdominal procedures with a median time to surgery of 1.83 years. We recorded a positive family history in 2.7%, 8.2%, and 10% of cases for CD, UC, and IC, respectively. For both boys and girls with CD, but only for boys with UC, height standard deviation score became more negative over time.
  
  
  CONCLUSIONS
  This retrospective study quantifies certain distinctions between IBDs diagnosed in paediatric and adult populations. We document a trend toward male predominance in children with CD. We also note impaired linear growth in children with CD, whereas it appears maintained in girls with UC. We also have recorded a low incidence of IBDs in the families of this cohort and suggest that environmental influences may be of greater importance. We document that major intraabdominal surgery may be required in about 15% of patients with either UC or CD within 2 years of diagnosis, and that the majority of those diagnosed initially with IC will be reclassified as either UC or CD within 2 years.
authors.affiliation: Countess of Chester Hospital, Chester, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Newby
authors.forename: Nick M
authors.initials: NM
authors.lastname: Croft
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.forename: Kamal
authors.initials: K
authors.lastname: Hassan
authors.forename: Robert B
authors.initials: RB
authors.lastname: Heuschkel
authors.forename: Huw
authors.initials: H
authors.lastname: Jenkins
authors.forename: David H
authors.initials: DH
authors.lastname: Casson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors