الفهرس 
Inflammatory Bowel Diseases (IBDs)Only 14 pages are availabe for public view
 |  | from | 269 |  |  |
| | | from | 269 | | |
Abstract
I
nflammatory bowel diseases (IBDs) are group of complex and multifactorial disorders. The most common subtypes are Crohn’s disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBD-U). According to age of onset of the disease, Childhood IBD is classified into; Very early onset IBD (VEO-IBD) with age of onset below 6 years and pediatric-onset IBD (PIBD) with age of onset between 6 and 16 years.
VEO-IBD is believed to be more extensive at onset and more aggressive during follow-up compared to PIBD. So, in the current study we evaluated clinicopathologic predictors for response to therapy among group of children with VEO-IBD in comparison with group of PIBD.
This prospective cohort study was done in pediatric gastroenterology and endoscopy unit, Ain hams university, the study included all newly diagnosed children with IBD according to modified Porto criteria during the period from June 2020 to June 2022. We excluded children with cow milk protein allergy, primary gastrointestinal infections, eosinophilic gastrointestinal disease, and known humeral or cell mediated immunodeficiency.
All included children were subjected to full medical history taking including presenting symptom, associated gastrointestinal (GI) symptoms, systemic manifestations, and family history (FH) of a similar condition. Full clinical examination included anthropometry, abdominal examination, and inspection of the perianal area. Laboratory investigations included stool studies, complete blood counts, inflammatory markers ad immunological assessment. Full colonoscopy with attempt to examine the terminal ileum was done for all patients with multiple biopsies from each segment and esophagogastroduodenoscopy was done for all children with VEO-IBD and in presence of upper GI symptoms or suspicion of CD in children with PIBD.
During the study period, 70 children were diagnosed with IBD. They were classified according to age of onset of disease into 2 groups, 35 patients with VEO- IBD and 35 patients with PIBD. Gender distribution was similar among both groups; 14 males and 21 females in each group.
Children with VEO-IBD had significantly higher frequencies of rural residence, FH of a similar condition (3 cases with FH of UC, 1 with CD and 2 with IBD-U) and FH of still birth (4 cases).
Common clinical presentations in children with VEO-IBD included chronic diarrhea (85.7%), bleeding per rectum (82.9%), growth faltering (42.9%), recurrent fever (42.9%) and need for blood transfusion (63.3%). These frequencies were not significantly different from PIBD.
Laboratory investigations for children with VEO-IBD showed anemia in 91.4%, leukocytosis in 68.6%, thrombocytosis in 71.4% and hypoalbuminemia in 37.1%. only one patient with VEO-IBD has low immunoglobulins (low serum IgA) another patient has low cd markers (Low cd4&cd8) on the other hand among 4 patients with PIBD only 1 has low immunoglobulins.
During colonoscopy, Children with VEO-IBD have a significantly higher frequency of deep ulcers compared to children with PIBD. Stricture was found among 3 children with VEO -IBD and only 1 child with PIBD. The patients showed predominantly colonic affection with only 2 children with VEO-IBD and only one child with PIBD had terminal ileum affection.77% of children with VEO- IBD had moderate to severe colitis. Regarding the subtypes of IBD, Among the children with VEO-IBD, the diagnosis of IBD-U was the most common (45.7%), although a significant number of patients diagnosed with ulcerative colitis (34.3%). Among children with PIBD, UC was the most common subtype (65.7%) followed by CD (28.5%), only one patient with atypical UC and only one patient with IBD-U.
Diagnostic delay (>6 months) was significantly higher in VEO-¬IBD than in PIBD. The median diagnostic delay in VEOIBD and PIBD were 6 months and 2 months respective¬ly.
In our study we contribute the diagnostic delay to many factors include infections mimics of IBD and over the counter antibiotics are easily available and is often the first line of treatment, and diagnosis of cow’s milk protein allergy in this age group (<6 years).
The conventional induction therapy was successful in 41.5% of children with IBD. The response was lower among children with VEO-IBD (38.5%) compared to PIBD (56%). Biological therapy was the initial induction therapy “Top-Down regimen” in 13% of children with IBD; 17.5% of VEO-IBD and 8.5% of PIBD.
Biological therapy was the rescue induction therapy “Step-Up regimen” in 45.7% of children with IBD; 51.5% of VEO-IBD and 40% of PIBD.
In our study, biologics were used in 24 patients (68.8%) with VEO-IBD and 17 patients (48.6%) with PIBD, with adalimumab being the most com¬monly used. The response to biological induction therapy was 87.8% (36/41) among all children with IBD; 87.5% (21/24) in VEO-IBD and 88.3% (15/17) in PIBD.
7 out 24 children with VEO-IBD were non responders to medical treatment even on biological therapy,1 UC (14.3%), 2 CD (28.6%), 4 IBD-U (57. 1%).one of them had genetics study and was diagnosed IL 10 receptor gene.
“Step-down regimen” was done in 20% of children with VEO-IBD after achieved mucosal healing.