scholarly journals P501 Incidence and therapeutic management/treatment of very early onset inflammatory bowel disease during 2015–2020

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S485-S485
Author(s):  
G Ninh ◽  
V Wewer ◽  
C Jakobsen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Medical Treatment ◽  
Bowel Disease ◽  
Early Onset ◽  
Biological Therapy ◽  
Cumulative Risk ◽  
Immunomodulatory Therapy ◽  
Inflammatory Bowel

Abstract Background To investigate the incidence of very early onset inflammatory bowel disease (VEO-IBD) in a cohort representing two regions in Denmark during the period 2015–2019 and to assess the medical and surgical treatment. Methods All patients diagnosed with VEO-IBD within The Capital Region and The Zealand Region from January 1, 2015 to July 1, 2020 were included. Demographic and clinical data and medical and surgical treatment were extracted from the files. Results Forty patients with VEO-IBD were identified. The incidence rate was 2.0/100,000 (CI 95% 0.8–5.9) during the 2015–2019. Totally 35 patients (87.5%) received immunomodulatory therapy during follow-up. The cumulative risk of receiving immunomodulatory therapy after 1 year, 3 years and 5 years was 58% (95% CI 39–71), 88% (95% CI 70–95) and 91% (95% CI 73–97) respectively. Totally 23 patients (57.5%) received biological therapy. The cumulative risk of receiving biological therapy after 1 year, 3 years and 5 years was 37% (95% CI 19–50), 46% (95% CI 27–60) and 57% (95% CI 36–71) respectively. Six patients (15%) received vedolizumab. Four patients (10%) with VEO-IBD underwent a colectomy during the follow-up period of which two patients received vedolizumab. Conclusion The incidence of VEO-IBD was 2.0/100,000. Medical treatment with immunomodulators and biological therapy was used extensively, possibly reducing surgery. However, medical treatment remains a complicated balancing of the effect (anti-inflammatory), side effect (cancer risk) and surgery in VEO-IBD.

scholarly journals The Unique Disease Course of Children with Very Early onset-Inflammatory Bowel Disease

2019 ◽  
Author(s):  
Judith R Kelsen ◽  
Maire A Conrad ◽  
Noor Dawany ◽  
Trusha Patel ◽  
Rawan Shraim ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Targeted Therapy ◽  
Bowel Disease ◽  
Early Onset ◽  
Severe Disease ◽  
Disease Course ◽  
Poor Growth ◽  
Study Objective ◽  
Inflammatory Bowel

Abstract Background Insight into the pathogenesis of very early onset-inflammatory bowel disease (VEO-IBD) has expanded through the identification of causative monogenic defects detected in a subset of patients. However, the clinical course of this population remains uncertain. The study objective is to determine whether VEO-IBD is associated with more severe disease, defined as increased surgical intervention and growth failure, than older pediatric IBD. Secondary outcomes included therapeutic response and hospitalizations. Methods Subjects with IBD diagnosed younger than 6 years old (VEO-IBD) were compared with children diagnosed 6 to 10 (intermediate-onset) and older than 10 years of age (older-onset IBD). Metadata obtained from the medical record included age of onset, disease phenotype and location, surgeries, medical therapy, and comorbid conditions. Length of follow-up was at least 1 year from diagnosis. Results There were 229, 221, and 521 subjects with VEO, intermediate-onset, and older-onset IBD, respectively. Very early onset-inflammatory bowel disease subjects underwent more diverting ileostomies (P < 0.001) and colectomies (P < 0.001) than the older children. There was less improvement in weight- and height-for-age Z scores during the follow-up period in subjects with VEO-IBD. Additionally, subjects with VEO-IBD had higher rates of medication failure at 1 year and were more frequently readmitted to the hospital. Targeted therapy was successfully used almost exclusively in VEO-IBD. Conclusion Patients with VEO-IBD can have a more severe disease course with increased surgical interventions and poor growth as compared with older-onset IBD patients. Further, VEO-IBD patients are more likely to be refractory to conventional therapies. Strategies using targeted therapy in these children can improve outcome and, in some cases, be curative.

scholarly journals A191 TEN YEARS FOLLOW UP OF EARLY ONSET INFLAMMATORY BOWEL DISEASE PATIENTS- A SINGLE CENTER RETROSPECTIVE COHORT STUDY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 207-209
Author(s):  
A Eindor ◽  
L Meleady ◽  
L Alam ◽  
K Gena ◽  
Z Hamilton ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Early Onset ◽  
First Year ◽  
Biologic Treatment ◽  
Disease Characteristics ◽  
Inflammatory Bowel ◽  
Disease Location ◽  
Pediatric Ibd

Abstract Background Early onset inflammatory bowel disease (EOIBD) and Very early onset inflammatory bowel disease (VEOIBD) prevalence has been increasing over the last decades. These young patients have been known to have special disease characteristics and disease location. Although it is known that only a low percentage of these patients require biologic treatment after diagnosis, there is only scarce evidence about their long- term outcome and biologic requirements. Aims To assess the ten year outcome of early onset and very early onset IBD patients. Methods We retrospectively reviewed IBD patients diagnosed under 10 years of age, between January 2005 and December 2009, from the British Columbia (BC) Pediatric IBD database. Disease characteristics and symptoms at diagnosis were documented. The disease location and severity at diagnosis were documented according to the Paris classification. Data collected retrospectively included a ten year treatment follow up period, number of hospitalizations, corticosteroid courses and surgeries. These parameters were documented at three time points: after the first year, after five years and ten years. Results 68 patients under the age of 10 were diagnosed with IBD during the study period. 2 patients failed to meet inclusion criteria and were excluded. Median age at diagnosis was 6.06 (IQR 4.5–8.6). 47.7% of patients had Crohn’s disease and 71.2% were males. 63 patients completed the 5 year follow up, and 52 the 10-year period due to lack of follow up or transfer to adult care. After the first year of follow up 0% patients in the VEOIBD group and 5% patients in the EOIBD group were treated with biologic treatment, whereas after the 10-year period 42.3% and 29.6% of patients were treated with biologic therapy respectively (p=0.282). Overall, 4 patients underwent colectomy and 2 a small bowel resection. Conclusions Although the percentage of VEIBD and EOIBD patients receiving biologic treatment after ten years is higher than after the first year, it is still lower than what is reported in the literature in older pediatric IBD patients and adults. Funding Agencies None

scholarly journals P780 Medical treatment and surgery in patients with elderly-onset inflammatory bowel disease: 3-year follow-up of Epi-IBD 2010–2011 cohorts

2019 ◽  
Vol 13 (Supplement_1) ◽  
pp. S510-S511
Author(s):  
V Hernandez ◽  
J Martinez-Cadilla ◽  
E Langholz ◽  
D Christodoulou ◽  
S Turcan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Medical Treatment ◽  
Bowel Disease ◽  
Elderly Onset ◽  
Inflammatory Bowel

Pitfalls in Diagnosis of Early-Onset Inflammatory Bowel Disease

2017 ◽  
Vol 28 (01) ◽  
pp. 039-043 ◽  
Author(s):  
Paloma Triana Junco ◽  
Alba Sánchez Galán ◽  
Gerardo Prieto ◽  
Esther Ramos ◽  
Martha Muñoz Romo ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Medical Treatment ◽  
Bowel Disease ◽  
Early Onset ◽  
Surgical Complication ◽  
Ileoanal Anastomosis ◽  
Growth Failure ◽  
Final Diagnosis ◽  
Surgical Measures ◽  
Inflammatory Bowel

Aim The onset of inflammatory bowel disease (IBD) in patients younger than the age of 5 years is rare. Moreover, when there is exclusive colonic inflammation, diagnosis can be challenging. Our aim was to describe the difficulties and pitfalls in the diagnosis of early-onset IBD (eoIBD) and their repercussions in treatment decisions. Patients and Methods Patients with eoIBD (Crohn's disease [CD], ulcerative, and unclassified colitis) treated at our center between 1990 and 2016 were studied retrospectively. Demographic, clinical, medical, and surgical treatment data were analyzed. Results A total of 19 patients were diagnosed with eoIBD at 21 (1–46) months of age. Bloody diarrhea, growth failure, and abdominal pain were present in 90, 42, and 16%, respectively. After 9 (1–62) months from the onset, patients were classified as ulcerative colitis (nine), CD (two), and unclassified colitis (eight). Unresponsiveness to medical treatment was observed in 10 and prompted surgical assessment. A partial colectomy was performed in one, and nine underwent a total colectomy (one end stoma and eight ileoanal anastomosis [IAA]). At least one surgical complication occurred in 80% and ultimately six patients with an IAA required an end stoma. Overtime, final diagnosis of 5 out of the 10 surgical patients changed due to biopsy findings, unresponsiveness to medical treatment, or extraintestinal and perianal manifestations. After a 12-year (1–22) follow-up, 57.9% of the diagnoses of all patients were modified. Conclusion EoIBD poses a challenge due to ambiguous presentation and absence of specific diagnostic tests. Surgical evaluation is often needed and surgeons must be mindful of possible initial misdiagnosis, in addition to short- and long-term outcomes before deciding aggressive surgical measures as well as intestinal reconstruction.

scholarly journals P290 Long-term disease outcome of ulcerative colitis (UC) in South Ostrobothnia, Finland with a follow-up time of 25 years

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S297-S298
Author(s):  
K Kontola ◽  
P Oksanen ◽  
H Huhtala ◽  
H Tunturi-Hihnala ◽  
A Jussila
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Cumulative Risk ◽  
Population Based ◽  
Study Data ◽  
Disease Outcome ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Finland has one of the highest prevalence of inflammatory bowel disease (IBD), especially UC. There is scarce data about long-term disease outcome in UC in population-based cohorts. The aim was to evaluate the long-term clinical outcome of patients with UC in the region of South Ostrobothnia, a district in rural central western Finland with a population of about 190 000. Methods All patients treated with diagnosis of UC or IBDU (inflammatory bowel disease Unclassified) during years 1981–2000 were included in this study. Data were collected retrospectively from the patient registry of the Central Hospital of South Ostrobothnia until 1 August 2019. Results There were 589 patients with a median follow-up time of 25 years. Median age at the diagnosis was 34 years. 59% of patients were male, 93% had UC and 7% IBDU. According to Montreal classification 80% had extensive disease, 15% left-sided disease and 5% proctitis. Medical treatment used at any point during the disease is shown in Table 1. Twenty-two per cent of patients had colectomy. Of operated patients, (pan)proctocolectomy with ileostomy was performed to 50%, IPAA (ileal pouch anal anastomosis) to 40% and IRA (ileorectal anastomosis) to 3%. Median time from the diagnosis to surgery was 11 years; the risk of surgery is shown in Table 2. Twenty-six per cent of the operations were emergency surgeries. The mean age at the time of surgery was 49 years. The indications for colectomy are specified in Table 3. Cumulative risk of colorectal cancer (CRC) and biliary tract cancer was 3.2% and 1.7%, respectively. Twenty-eight per cent of patients died during follow-up, at the mean age of 72 years. The cause of death was recorded for 91/167 and the most common causes were cardiovascular disease and malignancy. Conclusion In this population-based cohort with surveillance of 25 years 22% patients with UC or IBDU were operated. Even after becoming available, biological medication is rarely used for UC patients diagnosed in the prebiologic era.

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