title: Clinical course and outcomes of diagnosing Inflammatory Bowel Disease in children 10 years and under: retrospective cohort study from two tertiary centres in the United Kingdom and in Italy.
abstract: BACKGROUND
  Most children with Inflammatory Bowel Disease (IBD) are diagnosed between 11 and 16 years of age, commonly presenting with features of typical IBD. Children with onset of gut inflammation under 5 years of age often have a different underlying pathophysiology, one that is genetically and phenotypically distinct from other children with IBD. We therefore set out to assess whether children diagnosed after the age of 5 years, but before the age of 11, have a different clinical presentation and outcome when compared to those presenting later.
  
  
  METHODS
  Retrospective cohort study conducted at two European Paediatric Gastroenterology Units. Two cohorts of children with IBD (total number = 160) were compared: 80 children diagnosed between 5 and 10 years (Group A), versus 80 children diagnosed between 11 and 16 (Group B). Statistical analysis included multiple logistic regression.
  
  
  RESULTS
  Group A presented with a greater disease activity (p = 0.05 for Crohn's disease (CD), p = 0.03 for Ulcerative Colitis (UC); Odds Ratio 1.09, 95 % Confidence Interval: 1.02-1.1), and disease extent (L2 location more frequent amongst Group A children with CD (p = 0.05)). No significant differences were observed between age groups in terms of gastro-intestinal and extra-intestinal signs and symptoms at disease presentation, nor was there a difference in the number of hospitalisations due to relapsing IBD during follow-up. However, children in Group A were treated earlier with immunosuppressants and had more frequent endoscopic assessments.
  
  
  CONCLUSIONS
  While clinicians feel children between 5 and 10 years of age have a more severe disease course than adolescents, our analysis also suggests a greater disease burden in this age group. Nevertheless, randomized trials to document longer-term clinical outcomes are urgently needed, in order to address the question whether a younger age at disease onset should prompt per se a more "aggressive" treatment. We speculate that non-clinical factors (e.g. genetics, epigenetics) may have more potential to predict longer term outcome than simple clinical measures such as age at diagnosis.
authors.affiliation: Cambridge University Hospitals, Addenbrooke's, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Box 116 Level 8, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK. markgasp@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Gasparetto
authors.affiliation: Padova University Hospital, Department of Women and Children's Health, Unit of Paediatric Gastroenterology, Padova, 35128, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Guariso
authors.affiliation: Padova University Hospital, Department of Women and Children's Health, Unit of Epidemiology and Community Medicine, Padova, 35128, Italy.
authors.forename: Laura Visona' Dalla
authors.initials: LV
authors.lastname: Pozza
authors.affiliation: Cambridge University Hospitals, Addenbrooke's, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Box 116 Level 8, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ross
authors.affiliation: Cambridge University Hospitals, Addenbrooke's, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Box 116 Level 8, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Heuschkel
authors.affiliation: Cambridge University Hospitals, Addenbrooke's, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Box 116 Level 8, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Matthias
authors.initials: M
authors.lastname: Zilbauer
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D003424:Crohn Disease / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D000069285:Infliximab / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D010976:Platelet Count; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D006454:Hemoglobins; D019804:Mesalamine; D000069285:Infliximab; D000068879:Adalimumab
keywords: Age; Children; Inflammatory Bowel Disease (IBD); Location; Outcomes; Presentation; Severity