Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort
Objective To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤5 years of age) inflammatory bowel disease (IBD). Study design Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational...
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| creator | Oliva-Hemker, Maria, MD Hutfless, Susan, PhD Al Kazzi, Elie S., MD, MPH Lerer, Trudy, MS Mack, David, MD LeLeiko, Neal, MD, PhD Griffiths, Anne, MD Cabrera, Jose, MD Otley, Anthony, MD Rick, James, MD Bousvaros, Athos, MD Rosh, Joel, MD Grossman, Andrew, MD Saeed, Shehzad, MD Kay, Marsha, MD Carvalho, Ryan, MD Keljo, David, MD, PhD Pfefferkorn, Marian, MD Faubion, William, MD Kappelman, Michael, MD Sudel, Boris, MD Schaefer, Marc E., MD Markowitz, James, MD Hyams, Jeffrey S., MD |
| description | Objective To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤5 years of age) inflammatory bowel disease (IBD). Study design Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. Results One hundred twelve children were ≤5 years of age with no child enrolled at |
| doi_str_mv | 10.1016/j.jpeds.2015.04.045 |
| format | Article |
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Study design Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. Results One hundred twelve children were ≤5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohn's disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids ( P < .01) and methotrexate ( P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine ( P < .0001) and thiopurine immunomodulators ( P < .0002). Conclusions Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time.]]></description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2015.04.045</identifier><identifier>PMID: 25982142</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Age of Onset ; Child ; Child, Preschool ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Infant ; Inflammatory Bowel Diseases - diagnosis ; Inflammatory Bowel Diseases - therapy ; Male ; North America ; Pediatrics ; Phenotype ; Prognosis ; Prospective Studies ; Registries</subject><ispartof>The Journal of pediatrics, 2015-09, Vol.167 (3), p.527-532.e3</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-6793185f1f254f162f8444a5ff9da5b79f1b33754dd74bb9fd688cffa78cff503</citedby><cites>FETCH-LOGICAL-c459t-6793185f1f254f162f8444a5ff9da5b79f1b33754dd74bb9fd688cffa78cff503</cites><orcidid>0000-0003-1316-3426 ; 0000-0002-9285-9108 ; 0000-0001-7699-1400</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022347615004291$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25982142$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oliva-Hemker, Maria, MD</creatorcontrib><creatorcontrib>Hutfless, Susan, PhD</creatorcontrib><creatorcontrib>Al Kazzi, Elie S., MD, MPH</creatorcontrib><creatorcontrib>Lerer, Trudy, MS</creatorcontrib><creatorcontrib>Mack, David, MD</creatorcontrib><creatorcontrib>LeLeiko, Neal, MD, PhD</creatorcontrib><creatorcontrib>Griffiths, Anne, MD</creatorcontrib><creatorcontrib>Cabrera, Jose, MD</creatorcontrib><creatorcontrib>Otley, Anthony, MD</creatorcontrib><creatorcontrib>Rick, James, MD</creatorcontrib><creatorcontrib>Bousvaros, Athos, MD</creatorcontrib><creatorcontrib>Rosh, Joel, MD</creatorcontrib><creatorcontrib>Grossman, Andrew, MD</creatorcontrib><creatorcontrib>Saeed, Shehzad, MD</creatorcontrib><creatorcontrib>Kay, Marsha, MD</creatorcontrib><creatorcontrib>Carvalho, Ryan, MD</creatorcontrib><creatorcontrib>Keljo, David, MD, PhD</creatorcontrib><creatorcontrib>Pfefferkorn, Marian, MD</creatorcontrib><creatorcontrib>Faubion, William, MD</creatorcontrib><creatorcontrib>Kappelman, Michael, MD</creatorcontrib><creatorcontrib>Sudel, Boris, MD</creatorcontrib><creatorcontrib>Schaefer, Marc E., MD</creatorcontrib><creatorcontrib>Markowitz, James, MD</creatorcontrib><creatorcontrib>Hyams, Jeffrey S., MD</creatorcontrib><title>Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description><![CDATA[Objective To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤5 years of age) inflammatory bowel disease (IBD). Study design Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. Results One hundred twelve children were ≤5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohn's disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids ( P < .01) and methotrexate ( P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine ( P < .0001) and thiopurine immunomodulators ( P < .0002). Conclusions Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time.]]></description><subject>Adolescent</subject><subject>Age of Onset</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Inflammatory Bowel Diseases - diagnosis</subject><subject>Inflammatory Bowel Diseases - therapy</subject><subject>Male</subject><subject>North America</subject><subject>Pediatrics</subject><subject>Phenotype</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsFu1DAUtBCILoUvQEI-csliO3YSH0AqS1sqLRSJgsTJ8jrPXYfEXuyk1f4CX43DLhy4ID3Z0vPMG3nmIfSckiUltHrVLbsdtGnJCBVLwnOJB2hBiayLqinLh2hBCGNFyevqBD1JqSOESE7IY3TChGwY5WyBfq56553RPf4UIYEf9eiCx9q3-MLdQfENdMQ3W4h6B9PoDP6gvb6FISNxsPgrxD0-17HfF9c-wYivvO31MOgx5Ie34R56_M4l0Amwy2PxWsdbwB9DHLf4bICYpT1ehW1uPEWPrO4TPDvep-jLxfnN6n2xvr68Wp2tC8OFHIuqliVthKWWCW5pxWzDOdfCWtlqsamlpZuyrAVv25pvNtK2VdMYa3U9n4KUp-jlYe4uhh8TpFENLhnoe-0hTEnRmjQye1VVGVoeoCaGlCJYtYtu0HGvKFFzCKpTv0NQcwiK8Fwis14cBabNAO1fzh_XM-D1AQD5m3cOokrGgTfQughmVG1w_xF48w_fHFP8DntIXZiizw4qqhJTRH2e92BeAyoI4UzS8hcnKK90</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Oliva-Hemker, Maria, MD</creator><creator>Hutfless, Susan, PhD</creator><creator>Al Kazzi, Elie S., MD, MPH</creator><creator>Lerer, Trudy, MS</creator><creator>Mack, David, MD</creator><creator>LeLeiko, Neal, MD, PhD</creator><creator>Griffiths, Anne, MD</creator><creator>Cabrera, Jose, MD</creator><creator>Otley, Anthony, MD</creator><creator>Rick, James, MD</creator><creator>Bousvaros, Athos, MD</creator><creator>Rosh, Joel, MD</creator><creator>Grossman, Andrew, MD</creator><creator>Saeed, Shehzad, MD</creator><creator>Kay, Marsha, MD</creator><creator>Carvalho, Ryan, MD</creator><creator>Keljo, David, MD, PhD</creator><creator>Pfefferkorn, Marian, MD</creator><creator>Faubion, William, MD</creator><creator>Kappelman, Michael, MD</creator><creator>Sudel, Boris, MD</creator><creator>Schaefer, Marc E., MD</creator><creator>Markowitz, James, MD</creator><creator>Hyams, Jeffrey S., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1316-3426</orcidid><orcidid>https://orcid.org/0000-0002-9285-9108</orcidid><orcidid>https://orcid.org/0000-0001-7699-1400</orcidid></search><sort><creationdate>20150901</creationdate><title>Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort</title><author>Oliva-Hemker, Maria, MD ; Hutfless, Susan, PhD ; Al Kazzi, Elie S., MD, MPH ; Lerer, Trudy, MS ; Mack, David, MD ; LeLeiko, Neal, MD, PhD ; Griffiths, Anne, MD ; Cabrera, Jose, MD ; Otley, Anthony, MD ; Rick, James, MD ; Bousvaros, Athos, MD ; Rosh, Joel, MD ; Grossman, Andrew, MD ; Saeed, Shehzad, MD ; Kay, Marsha, MD ; Carvalho, Ryan, MD ; Keljo, David, MD, PhD ; Pfefferkorn, Marian, MD ; Faubion, William, MD ; Kappelman, Michael, MD ; Sudel, Boris, MD ; Schaefer, Marc E., MD ; Markowitz, James, MD ; Hyams, Jeffrey S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-6793185f1f254f162f8444a5ff9da5b79f1b33754dd74bb9fd688cffa78cff503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Age of Onset</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infant</topic><topic>Inflammatory Bowel Diseases - diagnosis</topic><topic>Inflammatory Bowel Diseases - therapy</topic><topic>Male</topic><topic>North America</topic><topic>Pediatrics</topic><topic>Phenotype</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oliva-Hemker, Maria, MD</creatorcontrib><creatorcontrib>Hutfless, Susan, PhD</creatorcontrib><creatorcontrib>Al Kazzi, Elie S., MD, MPH</creatorcontrib><creatorcontrib>Lerer, Trudy, MS</creatorcontrib><creatorcontrib>Mack, David, MD</creatorcontrib><creatorcontrib>LeLeiko, Neal, MD, PhD</creatorcontrib><creatorcontrib>Griffiths, Anne, MD</creatorcontrib><creatorcontrib>Cabrera, Jose, MD</creatorcontrib><creatorcontrib>Otley, Anthony, MD</creatorcontrib><creatorcontrib>Rick, James, MD</creatorcontrib><creatorcontrib>Bousvaros, Athos, MD</creatorcontrib><creatorcontrib>Rosh, Joel, MD</creatorcontrib><creatorcontrib>Grossman, Andrew, MD</creatorcontrib><creatorcontrib>Saeed, Shehzad, MD</creatorcontrib><creatorcontrib>Kay, Marsha, MD</creatorcontrib><creatorcontrib>Carvalho, Ryan, MD</creatorcontrib><creatorcontrib>Keljo, David, MD, PhD</creatorcontrib><creatorcontrib>Pfefferkorn, Marian, MD</creatorcontrib><creatorcontrib>Faubion, William, MD</creatorcontrib><creatorcontrib>Kappelman, Michael, MD</creatorcontrib><creatorcontrib>Sudel, Boris, MD</creatorcontrib><creatorcontrib>Schaefer, Marc E., MD</creatorcontrib><creatorcontrib>Markowitz, James, MD</creatorcontrib><creatorcontrib>Hyams, Jeffrey S., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oliva-Hemker, Maria, MD</au><au>Hutfless, Susan, PhD</au><au>Al Kazzi, Elie S., MD, MPH</au><au>Lerer, Trudy, MS</au><au>Mack, David, MD</au><au>LeLeiko, Neal, MD, PhD</au><au>Griffiths, Anne, MD</au><au>Cabrera, Jose, MD</au><au>Otley, Anthony, MD</au><au>Rick, James, MD</au><au>Bousvaros, Athos, MD</au><au>Rosh, Joel, MD</au><au>Grossman, Andrew, MD</au><au>Saeed, Shehzad, MD</au><au>Kay, Marsha, MD</au><au>Carvalho, Ryan, MD</au><au>Keljo, David, MD, PhD</au><au>Pfefferkorn, Marian, MD</au><au>Faubion, William, MD</au><au>Kappelman, Michael, MD</au><au>Sudel, Boris, MD</au><au>Schaefer, Marc E., MD</au><au>Markowitz, James, MD</au><au>Hyams, Jeffrey S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>167</volume><issue>3</issue><spage>527</spage><epage>532.e3</epage><pages>527-532.e3</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract><![CDATA[Objective To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤5 years of age) inflammatory bowel disease (IBD). Study design Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. Results One hundred twelve children were ≤5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohn's disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids ( P < .01) and methotrexate ( P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine ( P < .0001) and thiopurine immunomodulators ( P < .0002). Conclusions Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25982142</pmid><doi>10.1016/j.jpeds.2015.04.045</doi><orcidid>https://orcid.org/0000-0003-1316-3426</orcidid><orcidid>https://orcid.org/0000-0002-9285-9108</orcidid><orcidid>https://orcid.org/0000-0001-7699-1400</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The Journal of pediatrics, 2015-09, Vol.167 (3), p.527-532.e3 |
| issn | 0022-3476 1097-6833 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1708900066 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Age of Onset Child Child, Preschool Disease Progression Female Follow-Up Studies Humans Infant Inflammatory Bowel Diseases - diagnosis Inflammatory Bowel Diseases - therapy Male North America Pediatrics Phenotype Prognosis Prospective Studies Registries |
| title | Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort |
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