title: Phenotype and disease course of early-onset pediatric inflammatory bowel disease.
abstract: BACKGROUND
  Early-onset (EO) pediatric inflammatory bowel diseases (IBD) seem to be more extensive than those with a later onset. To test this hypothesis, we examined the phenotype and disease course of patients with IBD diagnosis at 0 to 5 years, compared with the ranges 6 to 11 and 12 to 18 years.
  
  
  METHODS
  Anatomic locations and behaviors were assessed according to Paris classification in 506 consecutive patients: 224 Crohn's disease, 245 ulcerative colitis, and 37 IBD-unclassified.
  
  
  RESULTS
  Eleven percent of patients were in the range 0 to 5 years, 39% in 6 to 11 years, and 50% in 12 to 18 years. Ulcerative colitis was the most frequent diagnosis in EO-IBD and in 6- to 11-year-old group, whereas Crohn's disease was predominant in older children. A classification as IBD-unclassified was more common in the range 0 to 5 years compared with the other groups (P < 0.005). EO Crohn's disease showed a more frequent isolated colonic (P < 0.005) and upper gastrointestinal involvement than later-onset disease. Sixty-two percent of the patients in the 0 to 5 years range had pancolonic ulcerative colitis, compared with 38% of 6 to 11 years (P = 0.02) and 31% of 12-18 years (P = 0.002) range. No statistical difference for family history for IBD was found in the 3-year age groups. Therapies at the diagnosis were similar for all children. However, at latest follow-up, a significantly higher proportion of younger children were under steroids compared with older groups (P < 0.05). Surgical risk did not differ according to age.
  
  
  CONCLUSIONS
  EO-IBD exhibits an extensive phenotype and benefit from aggressive treatment strategies, although surgical risk is similar to later-onset disease. A family history for IBD is not common in EO disease.
authors.affiliation: 1Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy; 2Gastroenterology and Nutrition Unit, Meyer Pediatric Hospital, Florence, Italy; 3Gastroenterology and Endoscopy Unit, G. Gaslini Institute for Children, Genoa, Italy; 4Department of Pediatric Gastroenterology, University of Padua, Padua, Italy; 5Pediatric Gastroenterology, University of Messina, Messina, Italy; 6Pediatric Department, Buzzi Children's Hospital of Milan, Milan, Italy; 7Pediatric Gastroenterology and Endoscopy, University of Messina, Messina, Italy; 8Pediatric Gastroenterology and Endoscopy Unit, Spirito Santo Hospital, Pescara, Italy; 9Department of Pediatrics, University of Naples Federico II, Naples, Italy; 10Pediatric Department, Maggiore Hospital, Bologna, Italy; 11Pediatric Department, Giovanni XXIII Hospital, Bari, Italy; 12Pediatric Gastroenterology Unit, University of Turin, Turin, Italy; 13Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; and 14Department of Pediatrics, Institute of Child Health, IRCSS Burlo Garofalo, Trieste, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.forename: Paolo
authors.initials: P
authors.lastname: Lionetti
authors.forename: Arrigo
authors.initials: A
authors.lastname: Barabino
authors.forename: Graziella
authors.initials: G
authors.lastname: Guariso
authors.forename: Stefano
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authors.forename: Massimo
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authors.forename: Claudio
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authors.lastname: Romano
authors.forename: Giuliano
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authors.lastname: Lombardi
authors.forename: Erasmo
authors.initials: E
authors.lastname: Miele
authors.forename: Patrizia
authors.initials: P
authors.lastname: Alvisi
authors.forename: Paolo
authors.initials: P
authors.lastname: Diaferia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Baldi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Romagnoli
authors.forename: Marco
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authors.lastname: Gasparetto
authors.forename: Monica
authors.initials: M
authors.lastname: Di Paola
authors.forename: Monica
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authors.lastname: Muraca
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pellegrino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Stefano
authors.initials: S
authors.lastname: Martelossi
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003424:Crohn Disease / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010641:Phenotype; D012720:Severity of Illness Index