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P276 Extraintestinal manifestations in paediatric patients with inflammatory bowel disease

R. Shentova - Eneva1, M. Baycheva*1, P. Hadjiiski1, D. Kofinova1, P. Yaneva1

1University Paediatric Hospital, Department of Gastroenterology and Hepatology, Sofia, Bulgaria

Background

More than half of the paediatric patients with inflammatory bowel disease (IBD) develop extraintestinal manifestations (EIMs). The frequency varies depending on the used definition. Some authors differentiate ‘extraintestinal manifestations’ and ‘extraintestinal complications’, others use more broad term. EIMs may occur before or after IBD diagnosis and usually parallel the disease activity. The aim of our study was to assess the prevalence of EIMs in paediatric patients with IBD and to analyse the connections between EIMs and disease type, duration, extent and activity.

Methods

A single-centre retrospective observational study including children and adolescents diagnosed with IBD, treated in the Department of Gastroenterology and Hepatology at the University Paediatric Hospital ‘Prof. Ivan Mitev’, Sofia for the period March 2011–October 2018. All observed EIMs were analysed.

Results

Totally 91 children were included in the final analysis—51 with ulcerative colitis (UC) and 40 with Crohn’s disease (CD). The median age of the participants at IBD diagnosis was 14 years (range 2–17 years). The median follow-up was 36 months (1–180 months). Fifty-five patients (60.4%) experienced at least one EIM. The most prevalent EIMs were anaemia 34.1% (31/55), growth failure 6.6% (6/55), and arthritis 5.5% (5/55). Other rare EIMs such as glomerulonephritis (2/55) and pyoderma gangrenosum (1/55) were also observed in our patients. In 18.2% (10/55) of the cases, the EIMs preceded the IBD diagnosis, in 32.7% (18/55) were identified at IBD diagnosis and in 49.1% (27/55) EIMs developed subsequently within the disease course. There were no statistically significant differences in the rates of EIMs between UC and CD patients (60.8% vs. 60%, p = 0.938). Of the UC patients with EIMs 61.3% (19/31) were girls and 38.7% (12/31) were boys; 58.1% (18/31) had pancolitis, 12.9% (4/31) extensive colitis, 25.8% (8/31) left sided colitis and 3.2% (1/31) ulcerative proctitis. Of the CD patients with EIMs 41.6% (10/24) were girls and 58.4% (14/24) were boys; 70.8% (17/24) had ileocolonic disease, 16.6% (4/24) colonic disease and 12.6% (3/24) ileal disease. The majority of EIMs observed were associated with an active underlying disease.

Conclusion

EIMs are common in paediatric patients with IBD. Children with longer disease duration and more extensive disease are at higher risk to develop EIMs.