Extraintestinal manifestations in pediatric inflammatory bowel disease (a single-center experience from the Middle East)

Abstract

Background Inflammatory bowel disease (IBD) may be considered a systemic disease because it is usually associated with variable extraintestinal manifestations (EIMs) that may affect almost every organ in the human body. High frequency of EIMs in pediatric IBD patients is reported from Western literature, while there is a scarcity of data on EIMs in Middle Eastern children. Aim This study aimed to assess the prevalence of in EIMs Egyptian pediatric IBD patients and to assess their to age, sex, disease subtype, disease location, and the need for biologics. Patients and methods A retrospective descriptive analytical study was conducted at Alexandria University Children’s Hospital (AUCH) on confirmed IBD cases (0–17 years old), diagnosed over a 3-year period 2017–2020. The diagnosis of IBD was based on the ‘Porto’ criteria. EIMs were recorded. The prevalence and frequency of EIMs and its to age, sex, disease subtype, disease location, and the need for biologics were assessed. Results The study included 128 IBD patients, 57% of them were males, and 50% had ulcerative colitis. The mean age of onset was 8.26±3.9 years. EIMs were reported in 79 patients (61.7%). Crohn’s disease (CD) was the more predominant disease subtype among patients with EIMs (55.7%). The most common reported EIMs were joint manifestations, followed by aphthous stomatitis (75 and 57% of the cases, respectively). Extensive disease (Pancolitis in ulcerative colitis and Ileo-colitis in CD) was the common disease location in patients with EIMs. There was no association between perianal disease and EIMs in CD patients. Elevated CRP levels, hypoalbuminemia and anemia were more encountered in patients with EIMs. Higher need for biologics also was significantly more reported in patients with EIMs ( P =0.029). Conclusion Egyptian children with IBD have a high prevalence of EIMs. The most common EIMs are joint manifestations and aphthous stomatitis. EIMs are more frequently seen in CD, older children, and are related to more severe phenotype and/or extensive disease location.