Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease.
OBJECTIVE
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 (L1) 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.
Van Limbergen
Johan
J
Gastrointestinal Unit, Molecular Medicine Centre, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom. johanvanlimbergen@hotmail.com
Russell
Richard K
RK
Drummond
Hazel E
HE
Aldhous
Marian C
MC
Round
Nicola K
NK
Nimmo
Elaine R
ER
Smith
Linda
L
Gillett
Peter M
PM
McGrogan
Paraic
P
Weaver
Lawrence T
LT
Bisset
W Michael
WM
Mahdi
Gamal
G
Arnott
Ian D
ID
Satsangi
Jack
J
Wilson
David C
DC
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D003093:Colitis, Ulcerative / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003424:Crohn Disease / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology
D007155:Immunologic Factors