الفهرس | Only 14 pages are availabe for public view |
Abstract ABSTRACT Background: Inflammatory bowel diseases (IBDs) are group of complex and multifactorial disorders. The most common subtypes are Crohn’s disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBD-U). According to age of onset of the disease, Childhood IBD is classified into; Very early onset IBD (VEO-IBD) with age of onset below 6 years and pediatric-onset IBD (PIBD) with age of onset between 6 and 16 years. VEO-IBD is believed to be more extensive at onset and more aggressive during follow-up compared to PIBD. Aim of Work: We aimed to find out the clinicopathologic characteristics of children with VEO-IBD in comparison with PIBD. Methodology: This cross-sectional study was done in pediatric gastroenterology and endoscopy unit, Ain hams university, included all newly diagnosed children with IBD according to modified Porto criteria during the period from June 2020 to May 2021. All included patients were subjected to full medical history including presenting symptom, associated gastrointestinal (GI) symptoms, systemic manifestations, and family history (FH) of a similar condition. Full clinical examination included anthropometry, abdominal examination, and inspection of the perianal area. Laboratory investigations included stool studies, complete blood counts inflammatory markers ad immunological assessment. Full colonoscopy with attempt to examine the terminal ileum was done for all patients with multiple biopsies from each segment and esophagogastroduodenoscopy was done in presence of upper GI symptoms or suspicion of CD. Results: During the study period, 70 children were diagnosed with IBD. They were classified according to age of onset of disease into 2 groups, 35 patients with VEO- IBD and 35 patients with PIBD. Gender distribution was similar among both groups; 14 males and 21 females in each group. Children with VEO-IBD had significantly higher frequencies of rural residence, FH of a similar condition (3 cases with FH of UC, 1 with CD and 2 with IBD-U) and FH of still birth (4 cases). Common clinical presentations in children with VEO-IBD included chronic diarrhea (85.7%), bleeding per rectum (82.9%), growth faltering (42.9%), recurrent fever (42.9%) and need for blood transfusion (63.3%). These frequencies were not significantly different from PIBD (68.6%, 74.3%, 43.3 ,31.3% and 80%, respectively). Children with VEO-IBD had a significantly higher frequencies of oral ulcers (25.7%) compared to children with PIBD (5.7%), Perianal disease was found among 17.1% of children with VEO-IBD compared to 14.3% of PID with a significantly higher frequency skin tags in PIBD. Laboratory investigations for children with VEO-IBD showed anemia in 91.4%, leukocytosis in 68.6%, neutrophilia in 91.6%, thrombocytosis in 71.4% and hypoalbuminemia in 37.1%. These frequencies were not significantly different from PIBD (71.4%, 48.5%, 76.4% ,62.8 and 31.4%, respectively). Inflammatory markers including CRP and fecal calprotectin were markedly elevated in both groups. Colonoscopy in VEO-IBD showed moderate to severe colitis in 77%. Conclusion: Children with VEO-IBD have similar clinical presentations classic PIBD with higher frequencies of FH of similar condition and still birth and oral ulcers. This might reflect the higher frequency of monogenic pattern of inheritance among this group. |