title: The natural course of inflammatory bowel disease-indeterminate from childhood to adulthood: within a 25 year period.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD)-indeterminate is a subgroup of IBD that has features of both ulcerative colitis (UC) and Crohn's disease (CD).
  
  
  OBJECTIVE
  To determine the clinical course of IBD-indeterminate in children over a 25 year period.
  
  
  METHODS
  We performed a retrospective investigation on children diagnosed with IBD. Diagnosis and disease distribution of IBD was based on clinical, radiologic, endoscopic, and histologic examinations.
  
  
  RESULTS
  Four hundred and twenty children diagnosed with IBD between 1986 and 2003 were identified from the IBD registry, 78 (22%) of whom were diagnosed with IBD-indeterminate. The mean age at diagnosis was 9.2 ± 4 years and the mean follow-up period was 4.1 ± 2 years. In 2003, 18 of 78 children (23%) were reclassified by the same physician based on the endoscopic and pathologic findings as follows: eight children with CD, five children with UC, and five children with non-IBD (eg, eosinophilic colitis). During 2011, 20 of the 60 patients who had maintained an IBD-indeterminate diagnosis were located and contacted, and detailed telephone interviews were conducted by the corresponding author. Two patients were reclassified as having CD (10%), one patient was reclassified as having eosinophilic colitis (5%), six patients remained with IBD-indeterminate (30%), and eleven patients (55%) reported a complete resolution of their symptoms. The follow-up period ranged from 10-18 years (mean 12.5 ± 3 years). Children who were reclassified as having CD were significantly younger than those who maintained an IBD-indeterminate diagnosis (6.4 ± 4 years versus11.2 ± 3 years, respectively, P = 0.05).
  
  
  CONCLUSIONS
  Children with IBD-indeterminate remain classified as IBD-indeterminate, or were clinically reclassified as CD or non-IBD, or became asymptomatic as they transitioned into adulthood. The need for IBD-indeterminate classification is of importance, especially when deciding on management and treatment.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Hoda M
authors.initials: HM
authors.lastname: Malaty
authors.forename: Seema
authors.initials: S
authors.lastname: Mehta
authors.forename: Bincy
authors.initials: B
authors.lastname: Abraham
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Garnett
authors.forename: George D
authors.initials: GD
authors.lastname: Ferry
keywords: IBD-indeterminate; children; clinical course; epidemiology
references.citation: J Pediatr Gastroenterol Nutr. 2010 Jan;50(1):27-31
references.pmid: 19934770
references.citation: Gastroenterology. 2004 May;126(6):1504-17
references.pmid: 15168363
references.citation: J Pediatr Gastroenterol Nutr. 2000 Mar;30(3):259-64
references.pmid: 10749408
references.citation: J Pediatr Gastroenterol Nutr. 1991 Oct;13(3):293-7
references.pmid: 1791507
references.citation: Inflamm Bowel Dis. 2006 Apr;12(4):258-62
references.pmid: 16633047
references.citation: Inflamm Bowel Dis. 2006 Aug;12(8):677-83
references.pmid: 16917221
references.citation: Eur J Gastroenterol Hepatol. 1999 Aug;11(8):909-13
references.pmid: 10514127
references.citation: J Clin Gastroenterol. 2012 Aug;46(7):581-9
references.pmid: 22772738
references.citation: Gastroenterology. 2004 May;126(6):1550-60
references.pmid: 15168366
references.citation: Int Surg. 1994 Apr-Jun;79(2):120-3
references.pmid: 7928146
references.citation: J Pediatr Gastroenterol Nutr. 2007 May;44(5):555-60
references.pmid: 17460486
references.citation: Inflamm Bowel Dis. 2009 Jan;15(1):63-8
references.pmid: 18626963
references.citation: J Pediatr Gastroenterol Nutr. 1993 Jul;17(1):32-8
references.pmid: 8102399
references.citation: Am J Gastroenterol. 2009 Mar;104(3):722-7
references.pmid: 19209163
references.citation: Acta Paediatr. 1994 Jun;83(6):640-5
references.pmid: 7919763
references.citation: Lancet. 2007 May 12;369(9573):1641-57
references.pmid: 17499606
references.citation: J Pediatr Gastroenterol Nutr. 2005 Oct;41(4):416-21
references.pmid: 16205508
references.citation: Clin Gastroenterol Hepatol. 2008 Dec;6(12):1361-9
references.pmid: 18848910
references.citation: J Pediatr. 2003 Oct;143(4):525-31
references.pmid: 14571234
references.citation: J Clin Gastroenterol. 2004 May-Jun;38(5 Suppl 1):S41-3
references.pmid: 15115931