P231. Early onset inflammatory bowel disease: phenotype and burden of disease. Experience at Cambridge University Hospitals - United Kingdom
M. Gasparetto1, G. Guariso2, F. Torrente1, M. Brennan3, R. Heuschkel1, M. Zilbauer1, 1Addenbrooke's - Cambridge University Hospitals NHS, Children's Services - Paediatric Gastroenterology Unit, Cambridge, United Kingdom, 2University Hospital of Padua, Women and Children's Health, Paediatric Gastroenterology Unit, Padova, Italy, 3Addenbrooke's - Cambridge University Hospitals NHS, Children' Services - Paediatric Gastroenterology Unit, Cambridge, United Kingdom
Up to 25% of patients with Inflammatory Bowel Disease (IBD) first present during childhood or adolescence, with early-onset diseases increasingly reported. Data on early onset IBD are scattered and the few studies conducted as yet seem to identify a more extensive and aggressive phenotype. This study was aimed to investigate the clinical features and to evaluate the burden of disease in a cohort of children diagnosed with IBD below the age of 11 years (yrs).
A retrospective chart review was performed on a cohort of paediatric patients diagnosed with IBD below the age of 11 yrs (Group 1), who were compared to a second cohort of randomly matched (for age and sex) children diagnosed between 12 and 15 yrs (Group 2).
41 children were enrolled in Group 1 (24 males, mean±SD follow-up per patient 2.8±2.24 yrs; diagnoses:14 ulcerative colitis (UC), 15 Crohn's disease (CD), 8 IBD-Unclassified (IBD-U) UC-like and 4 IBD-U CD-like) and compared to 41 children enrolled in Group 2 (25 males, mean±SD follow-up per patient 1.8±1.2 yrs; diagnoses:7 UC, 19 CD, 9 IBD-U UC-like and 6 IBD-U CD-like). Assessing disease distribution, extraintestinal manifestation and perianal disease at diagnosis (dg), no major differences were observed between both groups. Specifically, disease localisation (Montreal Classification) for CD and IBD-U CD-like was predominantly ileo-colonic both in Group 1 (9 L3+L4a, 2 L3+L4b) and in Group 2 (3 L3, 17 L3+L4a). UC and IBD-U UC-like patients mostly presented with a pancolonic localisation (E4) in both Groups (19 in Group1 and 11 in Group2). Regarding disease activity at dg, the mean Paediatric Crohn's Disease Activity Index (PCDAI) was 44.4±3.7 in Group 1 vs 32.7±2.2 in Group 2 (p = 0.006) and the mean Paediatric Ulcerative Colitis Activity Index (PUCAI) was 56.5±9.3 in Group1 vs 40.4±10.1 in Group 2 (p < 0.001). With regard to the burden of disease, no significant difference between the two Groups was observed in the mean number of relapses per patient per year (0.89±0.6 in Group 1 vs 0.95±0.71 in Group 2) as well as in the number of inpatient days (1.79±2.7 in Group 1 vs 1.64±2.9 in Group 2).
While disease distribution, presence of extraintestinal manifestation and perianal disease at dg did not appear to be different in the two groups, our cohort of patients diagnosed below 11 yrs showed a significantly higher disease activity at dg. Nevertheless, this hasn't reflected on a major disease burden in terms of number of relapses and hospitalisation days. Our results provide further evidence for a more aggressive phenotype in children with early-onset IBD, however these preliminary data still do not suggest that a top-down treatment strategy in this group might be more appropriate.