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P700 Incidence and phenotype at diagnosis in very early-onset paediatric inflammatory bowel disease: a population-based study (1988–2011)

E. Bequet1, H. Sarter2, M. Fumery3, L. Armengol-Debeir4, B. Pariente5, D. Ley6, C. Spyckerelle7, H. Coevoet8, L. Peyrin-Biroulet9, G. Savoye*10, T. Dominique6, C. Gower-Rousseau11

1Centre Hospitalier Régional Universitaire, Gastroentérologie pédiatrique, Lille, France, 2Chru, Epidémiologie, Lille, France, 3Université d’Amiens, Gastroentérologie, Amiens, France, 4Université de Rouen, Gastroentérologie, Rouen, France, 5chru, Gastoentérologie, Lille, France, 6Chru, Gastroentérologie pédiatrique, Lille, France, 7Hopital Saint-Vincent - Université catholique, Pédiatrie, Lille, France, 8Hôpital Les bonnettes, Arras, France, 9Chu, Gastroentérologie, Nancy, France, 10Chu Rouen, Gastroentérologie, Rouen, France, 11Chru, Lille, France

Background

More and more studies are published on very early-onset (<6 years) inflammatory bowel disease (VEO-IBD), but their phenotype is still poorly known. Our goals were to answer 2 questions: (1) Is the incidence of VEO-IBD increasing? (2) Is there a different phenotype depending on age at diagnosis?

Methods

Data were obtained from a cohort of 1 412 children (< 17 years) with IBD enrolled in a prospective French population-based Registry from 1988 to 2011. Incidence, initial classification, clinical presentation, and phenotype at diagnosis were compared according to age at diagnosis (< 6 years and 6–16 years).

Results

In the study, 3% of the 1 412 children enrolled started the disease before the age of 6 years. The incidence of overall IBD in children increased from 3 per 100 000 in 1988–1990 to 6.3 per 100 000 in 2009–2011 (+110 %; p < 103–). The incidence of VEO-IBD remained stable (0.44 per 100 000 in 1988–1990 and 0.36 per 100 000 in 2009–2011), while it increased from 4.43 per 100 000 in 1988–1990 to 9.54 per 100.000 in 2009–2011 in 6–16 years group (+115%, p <103–). Crohn’s disease (CD) is the most common IBD, regardless of age, but the initial classification in ulcerative colitis (UC) and unclassified IBD (IBD-U) is more common in children under 6 years than in 6–16 years (40% vs 26%). Children diagnosed with VEO-IBD were more often diagnosed in hospital than those diagnosed after the age of 6 (69% vs 42%). Rectal bleeding and mucous stools are more common in children under 6 years; weight loss and abdominal pain are less than in 6–16 years group. Amongst the children with CD, isolated colonic disease is more common in < 6 years group (39% vs 14%).

Conclusion

The incidence of VEO-IBD has been low and stable since 1988, whereas the incidence amongst the 6–16 years group increased during the same period. CD is most present in the 2 age groups, but UC or IBD-U was more common amongst the VEO-IBD group. In CD, children < 6 years presented more rectal symptoms, presumably in relation to a high prevalence of isolated colonic CD.