Clinical Pattern of Early-Onset Inflammatory Bowel Disease in Saudi Arabia: A Multicenter National Study.
The objectives of this multicenter national study were to compare the clinical phenotype of early-onset inflammatory bowel disease (IBD) (EO-IBD) with IBD in older children and to examine whether there is any variability in consanguinity rate and familial aggregation in EO-IBD compared with later onset IBD.



A retrospective analysis was performed on children aged 0 to 14 years with IBD in 17 centers located in geographically distinct regions in Saudi Arabia, from 2003 to 2012. Data of patients with EO-IBD (0 to <6 yrs) were compared with those with later onset IBD (6-14 yrs). Moreover, we evaluated differences in clinical pattern of infantile or toddler onset IBD subgroup (0-3 yr) as compared with those presenting in older children.



Of 352 IBD patients identified during the 10-year study period, 76 children (21.6%) younger than 6 years were diagnosed with IBD. Among the Crohn's disease (CD) group, infantile or toddler onset CD subgroup showed a more frequent isolated colonic involvement (L2) than later-onset group (57% versus 20%; P = 0.002). Positive family history was significantly more common in the infantile or toddler onset ulcerative colitis subgroup (29.4% versus 4.2% in later onset ulcerative colitis; P < 0.0001). The consanguinity rate was significantly higher in the infantile or toddler onset CD subgroup as compared with later onset CD group (57.1% versus 25.3%; P = 0.04).



In conclusion, EO-IBD exhibits a unique clinical phenotype with a strikingly higher familial aggregation in early-onset ulcerative colitis. Our data suggest a significant genetic impact on the onset of CD in the very young children.
*Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, University of King Saud Bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia;†Department of Pediatrics, Gastroenterology Unit, King Saud University, Riyadh, Saudi Arabia;‡Department of Pediatric Gastroenterology, King Abdullah International Medical Research Center, National Guard Hospital-WR, King Saud Bin Abdulaziz University for Health Sceinces, Jeddah, Saudi Arabia;§Section of Pediatric Gastroenterology, Department of Pediatircs, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia;¶Section of Pediatric Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia;**Division of Pediatric Gastroenterology, Department of Pediatrics, Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; and††Division of Pediatric Gastroenterology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Abdulrahman
A
Al-Hussaini
Mohammad
M
El Mouzan
Mohammed
M
Hasosah
Ali
A
Al-Mehaidib
Khalid
K
ALSaleem
Omar I
OI
Saadah
Mohammed
M
Al-Edreesi
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D003106:Colon / Q000473:pathology*; D003241:Consanguinity; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D002658:Developmental Disabilities / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010641:Phenotype; D012189:Retrospective Studies; D012529:Saudi Arabia; D012737:Sex Factors