title: Extraintestinal manifestations of pediatric inflammatory bowel disease and their relation to disease type and severity.
abstract: 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.
authors.affiliation: Nationwide Children's Hospital, Columbus, OH 43205, USA. jennifer.dotson@natiowidechildrens.org
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dotson
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hyams
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Neal S
authors.initials: NS
authors.lastname: LeLeiko
authors.forename: David R
authors.initials: DR
authors.lastname: Mack
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Evans
authors.forename: Marian D
authors.initials: MD
authors.lastname: Pfefferkorn
authors.forename: Anne M
authors.initials: AM
authors.lastname: Griffiths
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Otley
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Joel R
authors.initials: JR
authors.lastname: Rosh
authors.forename: David
authors.initials: D
authors.lastname: Keljo
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Carvalho
authors.forename: Gitit
authors.initials: G
authors.lastname: Tomer
authors.forename: Petar
authors.initials: P
authors.lastname: Mamula
authors.forename: Marsha H
authors.initials: MH
authors.lastname: Kay
authors.forename: Benny
authors.initials: B
authors.lastname: Kerzner
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Christine R
authors.initials: CR
authors.lastname: Langton
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
mesh_terms: 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*