الفهرس 
INFLAMMATORY BOWEL DISEASES (IBDS)Only 14 pages are availabe for public view
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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.