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P278 Comparison of long-standing paediatric-onset and adult-onset inflammatory bowel disease

D. Trad1, H. Jlassi1, N. Bibani1, M. Sabbah1, A. Ouakaa*1, H. Elloumi1, D. Gargouri1

1Medicine Faculty of Tunis, Gastroenterology Department of Habib Thameur Hospital (Tunisia), Tunis, Tunisia

Background

Inflammatory bowel diseases (IBD) are chronic autoimmune conditions of the gut affecting both paediatric and adult patients. Multiple studies show that onset of IBD during childhood has a different disease pattern and more aggressive evolution compared with adult onset. The aim of the study was to analyse the natural history and the rate of complications of childhood-onset disease and to compare them with characteristics of adult-onset disease in patients.

Methods

A retrospective comparative study was conducted from January 2014 to December 2016. Seventy-nine patients with Crohn’s disease (CD) and 50 patients with ulcerative colitis (UC) were retrospectively divided into paediatric onset (age at diagnosis ≤ 18 years) and adult onset (>18 years) patients.

Results

Among the CD patients, 13 (16, 4%) had paediatric-onset. There was no significant difference in the location of the disease between paediatric-onset patients (L1: 46%, L2: 15%, L3: 38%, L4: 7%) and adult onset patients (L1: 34%, L2: 13%, L3: 53%, L4: 5%) at diagnosis or during follow-up. The comparison of the rate of intestinal complications between age groups yielded the following results: strictures were more frequent in adult-onset patients (66.6% vs. 46.1%, p = 0.1).The overall prevalence of abdominal penetrating disease was the same between the 2 groups (53.8% vs. 43.9%, p = 0.2). In addition, the rate of perianal fistulising disease was similar (30.7% vs. 28.7%, p = 0.1). The rate of resectional surgery was not different in paediatric- and adult-onset CD patients (61.5% vs. 68.1%, p = 0.1). The rates of the assessed treatments with anti-TNF-α antibodies were higher in paediatric CD onset (69.2% vs. 46.9%, p = 0.04). During the follow-up, the presence of extra intestinal manifestations was observed more often in the paediatric-onset group without significant difference (38.4% vs. 27.2%, p = 0.3). In UC patients, 20%( n = 10) of patients had a paediatric-onset disease. At the diagnosis, 23% had proctitis, 35% left-sided colitis and 42% extensive colitis. Paediatric-onset disease was associated with a higher rate of acute severe colitis (60% vs. 23%, p = 0.006) at diagnosis and increased risk for colectomy (30% vs. 10%, p = 0.004) .The rate of treatments with anti-TNF-α antibodies was higher in paediatric-onset patients without colectomy (60% vs. 22%, p = 0.03).

Conclusion

In our study, patients with paediatric-onset IBD exhibit a more severe disease: more stricturing in paediatric onset CD and more acute severe colitis in paediatric onset UC, explaining the more frequent require of immunomodulators therapy in this population.