Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort

Maria Oliva-Hemker, Susan Hutfless, Elie S. Al Kazzi, Trudy Lerer, David Mack, Neal Leleiko, Anne Griffiths, Jose Cabrera, Anthony Otley, James Rick, Athos Bousvaros, Joel Rosh, Andrew Grossman, Shehzad Saeed, Marsha Kay, Ryan Carvalho, David Keljo, Marian Pfefferkorn, William Alvis Faubion, Michael KappelmanBoris Sudel, Marc E. Schaefer, James Markowitz, Jeffrey S. Hyams

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)527-532.e3
JournalJournal of Pediatrics
Volume167
Issue number3
DOIs
StatePublished - Sep 1 2015

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Inflammatory Bowel Diseases
Crohn Disease
Ulcerative Colitis
Phenotype
Therapeutics
Immunologic Factors
Adrenal Cortex Hormones
Colonic Diseases
Mesalamine
North America
Methotrexate
Registries
Colon
Age Groups

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort. / Oliva-Hemker, Maria; Hutfless, Susan; Al Kazzi, Elie S.; Lerer, Trudy; Mack, David; Leleiko, Neal; Griffiths, Anne; Cabrera, Jose; Otley, Anthony; Rick, James; Bousvaros, Athos; Rosh, Joel; Grossman, Andrew; Saeed, Shehzad; Kay, Marsha; Carvalho, Ryan; Keljo, David; Pfefferkorn, Marian; Faubion, William Alvis; Kappelman, Michael; Sudel, Boris; Schaefer, Marc E.; Markowitz, James; Hyams, Jeffrey S.

In: Journal of Pediatrics, Vol. 167, No. 3, 01.09.2015, p. 527-532.e3.

Research output: Contribution to journalArticle

Oliva-Hemker, M, Hutfless, S, Al Kazzi, ES, Lerer, T, Mack, D, Leleiko, N, Griffiths, A, Cabrera, J, Otley, A, Rick, J, Bousvaros, A, Rosh, J, Grossman, A, Saeed, S, Kay, M, Carvalho, R, Keljo, D, Pfefferkorn, M, Faubion, WA, Kappelman, M, Sudel, B, Schaefer, ME, Markowitz, J & Hyams, JS 2015, 'Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort', Journal of Pediatrics, vol. 167, no. 3, pp. 527-532.e3. https://doi.org/10.1016/j.jpeds.2015.04.045
Oliva-Hemker, Maria ; Hutfless, Susan ; Al Kazzi, Elie S. ; Lerer, Trudy ; Mack, David ; Leleiko, Neal ; Griffiths, Anne ; Cabrera, Jose ; Otley, Anthony ; Rick, James ; Bousvaros, Athos ; Rosh, Joel ; Grossman, Andrew ; Saeed, Shehzad ; Kay, Marsha ; Carvalho, Ryan ; Keljo, David ; Pfefferkorn, Marian ; Faubion, William Alvis ; Kappelman, Michael ; Sudel, Boris ; Schaefer, Marc E. ; Markowitz, James ; Hyams, Jeffrey S. / Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort. In: Journal of Pediatrics. 2015 ; Vol. 167, No. 3. pp. 527-532.e3.
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abstract = "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.",
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AU - Oliva-Hemker, Maria

AU - Hutfless, Susan

AU - Al Kazzi, Elie S.

AU - Lerer, Trudy

AU - Mack, David

AU - Leleiko, Neal

AU - Griffiths, Anne

AU - Cabrera, Jose

AU - Otley, Anthony

AU - Rick, James

AU - Bousvaros, Athos

AU - Rosh, Joel

AU - Grossman, Andrew

AU - Saeed, Shehzad

AU - Kay, Marsha

AU - Carvalho, Ryan

AU - Keljo, David

AU - Pfefferkorn, Marian

AU - Faubion, William Alvis

AU - Kappelman, Michael

AU - Sudel, Boris

AU - Schaefer, Marc E.

AU - Markowitz, James

AU - Hyams, Jeffrey S.

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N2 - 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.

AB - 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.

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