Asian Institute of Gastroenterology, Hyderabad, India
© Copyright 2021. Korean Association for the Study of Intestinal Diseases. All rights reserved.
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Funding Source
The authors received no financial support for the research, authorship, and/or publication of this article.
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Author Contribution
Conceptualization: Banerjee R. Data curation: Pal P, Shava U, Ganesh G. Formal analysis: Pal P. Investigation: Pal P. Methodology: Banerjee R. Project administration: Banerjee R, Reddy DN. Resources: Banerjee R. Supervision: Banerjee R. Visualization: Banerjee R, Pal P. Writing - original draft: Banerjee R, Pal P, Nabi Z, Shava U, Ganesh G. Writing - review & editing: all authors. Approval of final manuscript: all authors.
IBD, inflammatory bowel disease; VEOIBD, very early onset IBD; LO-PIBD, later onset pediatric IBD; CD, Crohn’s disease; UC, ulcerative colitis; SD, standard deviation; IQR, interquartile range; EIM, extraintestinal manifestation; PSC, primary sclerosing cholangitis; ASA, aminosalicylic acid; ATT, anti-tubercular therapy.
Characteristics |
UC, No. (%) |
P-value |
CD, No. (%) |
P-value | ||
---|---|---|---|---|---|---|
VEOIBD (n=8) | LO-PIBD (n=105) | VEOIBD (n=13) | LO-PIBD (n=162) | |||
Age of onset (yr) | ||||||
Mean ± SD | 2.50 ± 1.41 | 13.66 ± 4.08 | 0.170 | 3.55 ± 1.44 | 13.51 ± 3.10 | < 0.001 |
Median (IQR) | 2.5 (1–4) | 15 (13–17) | 4 (2–5) | 14 (11.7–16) | ||
Diagnostic delay (mo) | 0.140 | 0.530 | ||||
Mean (range) | 6.2 (1–12) | 20.6 (1–120) | 19.0 (1–60) | 24.0 (1–120) | ||
SD | 3.3 | 27.4 | 20.4 | 28.3 | ||
Median (IQR) | 6 (3–9) | 11 (6–24) | 19 (3.25–36) | 12 (7–24) | ||
Clinical features | ||||||
Abdominal pain | 5 (62.5) | 59 (56.2) | 0.510 | 6 (46.2) | 121 (74.7) | 0.470 |
Diarrhea | 7 (87.5) | 82 (78.1) | 0.680 | 10 (76.9) | 102 (62.9) | 0.550 |
Blood in stool | 7 (87.5) | 88 (83.8) | 0.630 | 7 (53.8) | 51 (31.5) | 0.130 |
Mucus in stool | 6 (75.0) | 53 (50.5) | 0.270 | 4 (30.8) | 35 (21.6) | 0.490 |
Weight loss | 3 (37.5) | 49 (46.7) | 0.720 | 5 (38.5) | 86 (53.1) | 0.390 |
Fever | 3 (37.5) | 22 (20.9) | 0.370 | 5 (38.5) | 55 (33.9) | 0.770 |
EIMs | 2 (25.0) | 27 (25.7) | 0.660 | 3 (23.1) | 32 (19.8) | 0.500 |
Family history of IBD | 1 (12.5) | 10 (9.5) | 0.570 | 2 (15.4) | 15 (9.2) | 0.600 |
History of consanguinity | 2 (25.0) | 6 (5.7) | 0.090 | 1 (7.7) | 12 (7.4) | 0.640 |
Extent of disease (UC) | 0.680 | |||||
Proctitis (E1) | 2 (25.0) | 12 (11.4) | ||||
Procto-sigmoiditis (E2) | 1 (12.5) | 16 (15.2) | ||||
Upto hepatic flexure (E3) | 0 | 24 (22.9) | ||||
Pancolitis | 5 (62.5) | 53 (50.5) | ||||
Extent of disease (CD) | 0.310 | |||||
L1 (ileal) | 2 (15.4) | 53 (32.9) | ||||
L2 (colonic) | 4 (30.8) | 61 (37.7) | ||||
L3 (ileo-colonic) | 6 (46.1) | 40 (24.7) | ||||
L4a+L4ba | 1 (7.7) | 8 (5.0) | ||||
Disease behavior (CD) | 0.660 | |||||
Inflammatory (B1) | 9 (69.2) | 91 (56.2) | ||||
Stricturing (B2) | 3 (23.1) | 54 (33.3) | ||||
Fistulizing (B3) | 1 (7.7) | 17 (10.5) | ||||
Perianal (p) | 1 (7.7) | 12 (7.4) | 0.968 | |||
Disease severityb | 0.003 | < 0.001 | ||||
Mild disease | 0 | 37 (35.2) | 1 (7.7) | 53 (32.7) | ||
Moderate disease | 3 (37.5) | 55 (52.4) | 2 (15.4) | 97 (59.9) | ||
Severe disease | 5 (62.5) | 13 (12.3) | 10 (76.9) | 25 (15.4) | ||
Treatment history | ||||||
5-ASA | 8 (100.0) | 105 (100.0) | 1.000 | 11 (84.6) | 151 (93.2) | 0.250 |
Steroids | 6 (75.0) | 58 (55.2) | 0.460 | 10 (76.9) | 112 (69.1) | 0.600 |
Immunomodulators | 4 (50.0) | 44 (41.9) | 0.720 | 8 (61.5) | 96 (59.2) | 0.760 |
Biologics | 1 (12.5) | 6 (5.7) | 0.410 | 1 (7.7) | 9 (5.5) | 0.510 |
Surgery | 1 (12.5) | 2 (1.9) | 0.190 | 1 (7.7) | 28 (17.2) | 0.480 |
ATT | 0 | 2 (1.9) | 1.000 | 2 (15.4) | 27 (16.6) | 0.630 |
a VEOIBD is 0+1 and LO-PIBD is 3+5.
b UC was classified as Pediatric Ulcerative Colitis Activity Index and CD as Pediatric Crohn’s Disease Activity Index.
IBD, inflammatory bowel disease; VEOIBD, very early onset IBD; LO-PIBD, later onset pediatric IBD; UC, ulcerative colitis; CD, Crohn’s disease; SD, standard deviation; IQR, interquartile range; EIM, extraintestinal manifestation; ASA, aminosalicylic acid; ATT, anti-tubercular therapy.
Risk factor | OR | 95% CI | P-value |
---|---|---|---|
Ulcerative colitis | |||
Sex (male or female) | 1.59 | 0.68–3.75 | 0.28 |
Onset of symptoms (> 10 or ≤ 10 yr) | 0.21 | 0.04–1.07 | 0.06 |
ATT use (yes or no) | 0.72 | 0.04–12.76 | 0.82 |
Disease location (pancolitis or others) | 0.86 | 0.24–3.17 | 0.82 |
Family history (yes or no) | 1.91 | 0.53–2.68 | 0.67 |
Crohn’s disease | |||
Sex (male or female) | 0.72 | 0.37–1.41 | 0.34 |
Onset of symptoms (> 10 or ≤ 10 yr) | 1.78 | 0.69–4.59 | 0.23 |
ATT use (yes or no) | 0.63 | 0.26–1.52 | 0.30 |
Disease location (ileal or colonic) | 2.16 | 1.08–4.32 | 0.03a |
Family history (yes or no) | 1.94 | 0.59–6.23 | 0.27 |
Variable | VEOIBD, No. (%) | LO-PIBD, No. (%) | P-value |
---|---|---|---|
No. of patients | 22 (7.5) | 270 (92.5) | |
Ratio of CD:UC | 1.62:1 | 1.55:1 | |
Age of onset of symptom (yr) | < 0.001 | ||
Mean ± SD | 3.11 ± 1.49 | 13.91 ± 2.97 | |
Median (IQR) | 3 (2–4) | 15 (12–16) | |
Male sex | 18 (82) | 165 (61) | 0.053 |
Diagnostic delay | |||
Median (IQR) (mo) | 6 (2–30) | 12 (7–24) | 0.034 |
Diagnostic delay > 6 mo | 9 (40.9) | 213 (78.8) | < 0.001 |
Symptoms | |||
Diarrhea | 17 (77.2) | 184 (68.1) | 0.370 |
Blood in stool | 15 (68.2) | 142 (52.6) | 0.160 |
Mucus in stool | 11 (50.0) | 91 (33.7) | 0.120 |
Weight loss | 8 (36.4) | 136 (50.4) | 0.210 |
Abdominal pain | 11 (50.0) | 181 (67.0) | 0.110 |
Fever | 8 (36.4) | 78 (28.9) | 0.450 |
No. of patients with EIMs | 5 (22.7) | 59 (21.8) | 0.550 |
Uveitis | 1 (4.5) | 8 (2.9) | |
Skin | 2 (9.1) | 25 (9.2) | |
Arthritis | 3 (13.6) | 40 (14.8) | |
PSC | 0 | 2 (0.7) | |
Family history of IBD | 3 (13.6) | 25 (9.2) | 0.700 |
History of consanguinity | 3 (13.6) | 18 (6.6) | 0.380 |
History of appendicitis | 0 | 2 (0.7) | - |
Treatment received | |||
5-ASA | 20 (90.9) | 261 (96.7) | 0.190 |
Use of steroids | 14 (63.6) | 152 (56.3) | 0.500 |
Immunomodulators | 8 (36.4) | 68 (25.2) | 0.250 |
Use of biologics | 2 (9.1) | 15 (5.5) | 0.630 |
ATT | 1 (4.5) | 32 (11.8) | 0.490 |
History of surgery | 3 (13.6) | 29 (10.7) | 0.720 |
Characteristics | UC, No. (%) |
P-value | CD, No. (%) |
P-value | ||
---|---|---|---|---|---|---|
VEOIBD (n=8) | LO-PIBD (n=105) | VEOIBD (n=13) | LO-PIBD (n=162) | |||
Age of onset (yr) | ||||||
Mean ± SD | 2.50 ± 1.41 | 13.66 ± 4.08 | 0.170 | 3.55 ± 1.44 | 13.51 ± 3.10 | < 0.001 |
Median (IQR) | 2.5 (1–4) | 15 (13–17) | 4 (2–5) | 14 (11.7–16) | ||
Diagnostic delay (mo) | 0.140 | 0.530 | ||||
Mean (range) | 6.2 (1–12) | 20.6 (1–120) | 19.0 (1–60) | 24.0 (1–120) | ||
SD | 3.3 | 27.4 | 20.4 | 28.3 | ||
Median (IQR) | 6 (3–9) | 11 (6–24) | 19 (3.25–36) | 12 (7–24) | ||
Clinical features | ||||||
Abdominal pain | 5 (62.5) | 59 (56.2) | 0.510 | 6 (46.2) | 121 (74.7) | 0.470 |
Diarrhea | 7 (87.5) | 82 (78.1) | 0.680 | 10 (76.9) | 102 (62.9) | 0.550 |
Blood in stool | 7 (87.5) | 88 (83.8) | 0.630 | 7 (53.8) | 51 (31.5) | 0.130 |
Mucus in stool | 6 (75.0) | 53 (50.5) | 0.270 | 4 (30.8) | 35 (21.6) | 0.490 |
Weight loss | 3 (37.5) | 49 (46.7) | 0.720 | 5 (38.5) | 86 (53.1) | 0.390 |
Fever | 3 (37.5) | 22 (20.9) | 0.370 | 5 (38.5) | 55 (33.9) | 0.770 |
EIMs | 2 (25.0) | 27 (25.7) | 0.660 | 3 (23.1) | 32 (19.8) | 0.500 |
Family history of IBD | 1 (12.5) | 10 (9.5) | 0.570 | 2 (15.4) | 15 (9.2) | 0.600 |
History of consanguinity | 2 (25.0) | 6 (5.7) | 0.090 | 1 (7.7) | 12 (7.4) | 0.640 |
Extent of disease (UC) | 0.680 | |||||
Proctitis (E1) | 2 (25.0) | 12 (11.4) | ||||
Procto-sigmoiditis (E2) | 1 (12.5) | 16 (15.2) | ||||
Upto hepatic flexure (E3) | 0 | 24 (22.9) | ||||
Pancolitis | 5 (62.5) | 53 (50.5) | ||||
Extent of disease (CD) | 0.310 | |||||
L1 (ileal) | 2 (15.4) | 53 (32.9) | ||||
L2 (colonic) | 4 (30.8) | 61 (37.7) | ||||
L3 (ileo-colonic) | 6 (46.1) | 40 (24.7) | ||||
L4a+L4b |
1 (7.7) | 8 (5.0) | ||||
Disease behavior (CD) | 0.660 | |||||
Inflammatory (B1) | 9 (69.2) | 91 (56.2) | ||||
Stricturing (B2) | 3 (23.1) | 54 (33.3) | ||||
Fistulizing (B3) | 1 (7.7) | 17 (10.5) | ||||
Perianal (p) | 1 (7.7) | 12 (7.4) | 0.968 | |||
Disease severity |
0.003 | < 0.001 | ||||
Mild disease | 0 | 37 (35.2) | 1 (7.7) | 53 (32.7) | ||
Moderate disease | 3 (37.5) | 55 (52.4) | 2 (15.4) | 97 (59.9) | ||
Severe disease | 5 (62.5) | 13 (12.3) | 10 (76.9) | 25 (15.4) | ||
Treatment history | ||||||
5-ASA | 8 (100.0) | 105 (100.0) | 1.000 | 11 (84.6) | 151 (93.2) | 0.250 |
Steroids | 6 (75.0) | 58 (55.2) | 0.460 | 10 (76.9) | 112 (69.1) | 0.600 |
Immunomodulators | 4 (50.0) | 44 (41.9) | 0.720 | 8 (61.5) | 96 (59.2) | 0.760 |
Biologics | 1 (12.5) | 6 (5.7) | 0.410 | 1 (7.7) | 9 (5.5) | 0.510 |
Surgery | 1 (12.5) | 2 (1.9) | 0.190 | 1 (7.7) | 28 (17.2) | 0.480 |
ATT | 0 | 2 (1.9) | 1.000 | 2 (15.4) | 27 (16.6) | 0.630 |
Risk factor | OR | 95% CI | P-value |
---|---|---|---|
Ulcerative colitis | |||
Sex (male or female) | 1.59 | 0.68–3.75 | 0.28 |
Onset of symptoms (> 10 or ≤ 10 yr) | 0.21 | 0.04–1.07 | 0.06 |
ATT use (yes or no) | 0.72 | 0.04–12.76 | 0.82 |
Disease location (pancolitis or others) | 0.86 | 0.24–3.17 | 0.82 |
Family history (yes or no) | 1.91 | 0.53–2.68 | 0.67 |
Crohn’s disease | |||
Sex (male or female) | 0.72 | 0.37–1.41 | 0.34 |
Onset of symptoms (> 10 or ≤ 10 yr) | 1.78 | 0.69–4.59 | 0.23 |
ATT use (yes or no) | 0.63 | 0.26–1.52 | 0.30 |
Disease location (ileal or colonic) | 2.16 | 1.08–4.32 | 0.03 |
Family history (yes or no) | 1.94 | 0.59–6.23 | 0.27 |
IBD, inflammatory bowel disease; VEOIBD, very early onset IBD; LO-PIBD, later onset pediatric IBD; CD, Crohn’s disease; UC, ulcerative colitis; SD, standard deviation; IQR, interquartile range; EIM, extraintestinal manifestation; PSC, primary sclerosing cholangitis; ASA, aminosalicylic acid; ATT, anti-tubercular therapy.
VEOIBD is 0+1 and LO-PIBD is 3+5. UC was classified as Pediatric Ulcerative Colitis Activity Index and CD as Pediatric Crohn’s Disease Activity Index. IBD, inflammatory bowel disease; VEOIBD, very early onset IBD; LO-PIBD, later onset pediatric IBD; UC, ulcerative colitis; CD, Crohn’s disease; SD, standard deviation; IQR, interquartile range; EIM, extraintestinal manifestation; ASA, aminosalicylic acid; ATT, anti-tubercular therapy.
Statistically significant, OR, odds ratio; CI, confidence interval; ATT, anti-tubercular therapy.