Phenotype and clinical characteristics of early compared to late-onset pediatric inflammatory bowel disease.

Background and Aim: Early-onset (EO) pediatric inflammatory bowel diseases (IBD) seem to be more severe and extensive than those with a later-onset. To test this hypothesis we examined the phenotype and clinical characteristics of patients (pts) with IBD diagnosis at 0−5 years (yrs), compared to the ranges 6−11 and 12−18 yrs. S246 Oral Communications / Digestive and Liver Disease 44 Suppl. 4 (2012) S241–S257 Methods: Anatomic locations and behaviors were assessed in 505 consecutive IBD pediatric pts (54% males): 224 Crohn’s Disease (CD), 245 Ulcerative Colitis (UC) and 37 IBD-unclassified (IBDU). Data were collected between January 2009 and April 2012 and stored in the Pediatric Gastroenterology, Hepatology and Nutrition Italian Society (SIGENP) IBD web-registry, recently developed. Results: 11% of pts were in the range 0−5 yrs of age at the diagnosis, 39% in 6−11, and 50% in 12−18. UC was the most frequent diagnosis in EO-IBD and in 6−12 yrs old group, whereas CD was predominant in older children (p: 0.002). A classification as IBDU was more common in the range 0−5 yrs compared to the other groups (p: 0.005). EO-CD was characterized by a more frequent isolated colonic disease (p: 0.01). Seventy-nine % of the 0−5 yrs range pts had extensive UC, compared to 50% of 6−11 (p: 0.004) and 45% of 12−18 (p: 0.001) yrs range. A proctitis was diagnosed in 0.5% of 0−5 yrs age group, compared to 17% in 6−11 and 19% in 12−18 yrs ranges (p: 0.19). Most of younger pts received steroids and thiopurines at the diagnosis (58% and 55%, respectively), while use of steroids was reduced in older two age range pts (p: 0.001). Thirteen % of pts with EO-IBD underwent biological therapy within 1 year from the diagnosis (vs. 12% of 6−11 and 15% of 12−18 yrs range groups). There was no statistical difference for family history for IBD in the 3 age range groups. Conclusions: EO-IBD exhibit an extensive disease phenotype and benefit from more aggressive treatment strategies. A family history for IBD is not common in younger children. Long prospective studies are needed to define the natural history of EO disease.