Extraintestinal manifestations of pediatric inflammatory bowel disease and their relation to disease type and severity.
OBJECTIVE
Although it is known that extraintestinal manifestations (EIMs) commonly occur in pediatric inflammatory bowel disease (IBD), little research has examined rates of EIMs and their relation to other disease-related factors in this population. The purpose of this study was to determine the rates of EIMs in pediatric IBD and examine correlations with age, sex, diagnosis, disease severity, and distribution.


METHODS
Data were prospectively collected as part of the Pediatric IBD Collaborative Research Group Registry, an observational database enrolling newly diagnosed IBD patients <16 years old since 2002. Rates of EIM (occurring anytime during the period of enrollment) and the aforementioned variables (at baseline) were examined. Patients with indeterminate colitis were excluded from the analysis given the relatively small number of patients.


RESULTS
One thousand nine patients were enrolled (mean age 11.6 +/- 3.1 years, 57.5% boys, mean follow-up 26.2 +/- 18.2 months). Two hundred eighty-five (28.2%) patients experienced 1 or more EIMs. Eighty-seven percent of EIM occurred within the first year. Increased disease severity at baseline (mild vs moderate/severe) was associated with the occurrence of any EIM (P < 0.001), arthralgia (P = 0.024), aphthous stomatitis (P = 0.001), and erythema nodosum (P = 0.009) for both Crohn disease (CD) and ulcerative colitis (UC) during the period of follow-up. Statistically significant differences in the rates of EIMs between CD and UC were seen for aphthous stomatitis, erythema nodosum, and sclerosing cholangitis.


CONCLUSIONS
EIMs as defined in this study occur in approximately one quarter of pediatric patients with IBD. Disease type and disease severity were commonly associated with the occurrence of EIMs.
Dotson
Jennifer L
JL
Nationwide Children's Hospital, Columbus, OH 43205, USA. jennifer.dotson@natiowidechildrens.org
Hyams
Jeffrey S
JS
Markowitz
James
J
LeLeiko
Neal S
NS
Mack
David R
DR
Evans
Jonathan S
JS
Pfefferkorn
Marian D
MD
Griffiths
Anne M
AM
Otley
Anthony R
AR
Bousvaros
Athos
A
Kugathasan
Subra
S
Rosh
Joel R
JR
Keljo
David
D
Carvalho
Ryan S
RS
Tomer
Gitit
G
Mamula
Petar
P
Kay
Marsha H
MH
Kerzner
Benny
B
Oliva-Hemker
Maria
M
Langton
Christine R
CR
Crandall
Wallace
W
D000293:Adolescent; D018771:Arthralgia / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications*; D004893:Erythema Nodosum / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013281:Stomatitis, Aphthous / Q000453:epidemiology / Q000209:etiology*