P663. A nation-wide registry of paediatric inflammatory bowel disease: improvement of diagnostic workup and Paris Classification
K. Muller1, Hungarian Pediatric IBD2, M. Papp3, P. Lakatos4, G. Veres1, 1Semmelweis University, Ist Dept. of Pediatrics, Budapest, Hungary, 2Hungarian Society of Pediatric Gastroenterology, Hungary, 3University of Debrecen, 2nd Dept. of Medicine, Debrecen, Hungary, 4Semmelweis University, Ist Dept. of Medicine, Budapest, Hungary
A nationwide registry may serve as a mirror reflecting the quality of health care. It is a method for detecting failure in diagnostic workup or in management practice. We evaluated whether diagnostic workup of paediatric inflammatory bowel disease (IBD) patients fulfils Porto Criteria. Furthermore, we analyzed whether the diagnostic practice has changed since the Hungarian Paediatric IBD Registry exists. In addition, there has been no large paediatric IBD cohort analyzed according to Paris classification.
Newly diagnosed paediatric patients with IBD (0–18 years) are registered in this prospective registry. All the twentyseven paediatric institutes with paediatric gastroenterology serve data ensuring a nationwide approach. The questionnaire includes epidemiological data, disease extension, disease activity (PCDAI, PUCAI) and initial therapy.
Between 2007 and 2011, 712 new IBD cases were identified (449 Crohn's disease (CD), 217 ulcerative colitis (UC) and 46 IBD-unclassified). Upper endoscopy was performed in 52.6% of the patients in 2007, and this rate has increased to 78.2% by 2011. Proportion of ileoscopy has changed from 53% to 69%. Imaging of the small bowel did not change during the years (range: 31.2–42%), but the modality of imaging has altered. MRI was performed in 7.5% of patients in 2007 and in 24.8% in 2011. Localization (Paris classification) could be evaluated in 512 patients. 84/173 UC patients had E4 classification, 32 children had E3 localization and 10 cases presented with proctitis. S1 severity was found in 15 patients (11.5%) at diagnosis.
In CD 219 (64%) children had upper gastrointestinal involvement, 72.6% patients had L4a, 12.3% had L4b, and 15.1% had L4ab classification. Six patients (1.4%) belonged to B2B3, 10 children (2.3%) had B3 and 46 (10.4%) CD patients had B2 phenotype. Localization differed in age groups: involvement of the terminal ileum was significantly lower in A1a age group than in A1b (U=6216, p < 0.001) or A2 groups (U=768, p = 0.022). Perianal disease was significantly higher in patients with L4b than in L4a (25.9% vs. 9.4% p = 0.023). PCDAI was significantly higher in patients with L3 than in patients with L1 or L2 disease extension (35.9 vs. 28.2 (p = 0.001) and 35.9 vs. 27.2 p < 0.001).
The quality of diagnostic workup in paediatric patients with IBD improved in the last 5 years. Paris classification of the IBD patients seems to be a more precise classification, providing distinct subgroups for further analysis.