Very early onset versus pediatric onset inflammatory bowel disease: a prospective cohort analysis

Abstract

Background: Inflammatory bowel disease (IBD) in the pediatric age group is divided into two categories: very early onset IBD (VEO-IBD) and pediatric IBD (PIBD). The goal of this study was to determine the difference between the two entities concerning disease presentation, severity and treatment response. Methods: We conducted an observational prospective study that involved 70 newly diagnosed children with IBD, diagnosed using modified Porto criteria and followed up over a period of one year (35 VEO-IBD and 35 PIBD). It was conducted at the Pediatric Gastroenterology and Endoscopy Unit at Ain Shams University. Recruited cases were subjected to clinical assessment, and laboratory investigations including stool tests, full blood counts, and inflammatory markers in addition to ileo-colonoscopy and esophagogastroduodenoscopy. They were assessed initially and at follow-up for a total duration of one year for disease activity, treatment response, and disease relapse. Results: Gender distribution was similar among both VEO-IBD and PIBD groups. Rural residence (p=0.048), positive family history (p= 0.010), oral ulcers (p=0.022) and perianal skin tags (p=0.066) were more frequent among patients with VEO-IBD. Colonoscopy showed deeper ulcers in VEO-IBD (25.7%) than in PIBD (2.9%). Regression analysis showed that younger age (p=0.032) and high disease severity scores (p=0.011) were the main determinants of steroid non-responsiveness. Conclusion: Young age and severity score were the most predictive risk factors for steroid unresponsiveness in pediatric IBD