De Novo Crohn's Disease in Children With Ulcerative Colitis Undergoing Ileal Pouch-Anal Anastomosis: A Multicenter, Retrospective Study From the Pediatric IBD Porto Group of the ESPGHAN.

BACKGROUND AND AIMS: We sought to define the prevalence and to characterize possible predictive factors of Crohn's disease (CD) occurring in children with ulcerative colitis (UC) after ileal pouch-anal anastomosis (IPAA). METHODS: This was a multicenter, retrospective study including 15 centers of the Porto IBD group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Children with a confirmed diagnosis of UC undergoing colectomy with IPAA and a minimal follow up of 6 months were identified. The following data were collected: demographic data; endoscopic and histologic data; disease activity; laboratory exams; therapeutic history; indication for surgery, type, and timing; and IPAA functional outcomes and complications. In de novo CD cases, time of diagnosis, phenotype, location, and therapies were gathered. RESULTS: We identified 111 UC children undergoing IPAA from January 2008 to June 2018 (median age at colectomy: 13 years; age range: 1-18 years; female/male: 59/52). The median time from diagnosis to colectomy was 16 (range, 0-202) months. At the last follow-up, 40 (36%) of 111 children developed pouchitis. The criteria for de novo CD were met in 19(17.1%) of 111 children with a 25-month median (range, 3-61 months). At last follow-up, 12 (63.1%) of 19 were treated with biologics and in 5 (26.3%) of 19 children, the pouch was replaced with definitive ileostomy. In a multivariable logistic regression model, decreased preoperative body mass index z scores (odds ratio, 2.2; 95% confidence interval, 1.1-4.4; P = .01) resulted as the only variable associated with CD development. CONCLUSIONS: Children with UC undergoing IPAA carry a high risk of developing subsequent CD. De novo CD cases showed decreased preoperative body mass index z scores, identifying a poor nutritional status as a possible predictive factor.

This is the largest European study describing the prevalence of Crohn's disease (CD) development in children with ulcerative colitis undergoing subtotal colectomy with ileal pouch­anal anastomosis. Children affected by ulcerative colitis carry a higher risk when compared with adults to develop de novo CD after surgery. On the other hand, the multivariate analysis identified decreased values of preoperative body mass index z scores as a possible predictor of new-onset CD.

Disease impact on the quality of life of children with inflammatory bowel disease.

AIM: To assess the impact of disease characteristics on the quality of life (QOL) in children with inflammatory bowel diseases (IBD). METHODS: This was a cross-sectional study conducted at the First Department of Pediatrics of the University of Athens at the "Aghia Sophia" Children's Hospital. Children diagnosed with Crohn's disease (CD) or ulcerative colitis (UC), who were followed as outpatients or during a hospitalization, participated, after informed consent was obtained from their legal representative. QOL was assessed by the IMPACT-III questionnaire. Demographic data and disease characteristics were also collected. Statistical analyses included parametric (Student's t-test and Pearson's r) and non-parametric (Mann-Whitney test, Fisher's test and Spearman's rho) procedures. RESULTS: Ninety-nine patients (UC: 37, 73.0% females, CD: 62, 51.6% females), aged 12.8 ± 2.6 years were included. Overall, as well as, sub-domain scores did not differ between UC and CD (overall score: 73.9 ± 13.3 vs 77.5 ± 11.2, respectively, P = 0.16). In the entire sample, total score was related to physician's global assessment (PGA, patients classified as "mild/moderate" active disease had, on average, 14.8 ± 2.7 points lower total scores compared to those "in remission", P < 0.001) and age at IMPACT completion (Pearson's r = 0.29, P = 0.05). Disease activity assessed by the indices Pediatric Ulcerative Colitis activity index, Pediatric Crohn's disease activity index or PGA was significantly associated with all subdomains scores. Presence of extraintestinal manifestations had a negative impact on emotional and social functioning domains. CONCLUSION: Disease activity is the main correlate of QOL in children with IBD, underlining the importance of achieving and sustaining clinical remission.

Dental Caries and Periodontal Disease in Children and Adolescents with Inflammatory Bowel Disease: A Case-Control Study.

BACKGROUND: Previous reports have demonstrated a higher prevalence of dental caries and periodontal disease in adults with inflammatory bowel disease (IBD), but similar data in children and adolescents do not exist. The aim of the study was to evaluate the status of dental caries, oral hygiene, gingival status and periodontal treatment needs of children with IBD. METHODS: In this case-control study, 55 children on remission from a single outpatient IBD clinic, aged 4 to 18 years (12.27 ± 3.67 yr) and 55 matched systemically healthy controls of a dental practice were assessed prospectively. The evaluation included medical history, dental questionnaire in both groups, and previous and current medical therapy of children with IBD. Additionally, the decayed, missing, and filled tooth (dmf-t or DMF-T), simplified gingival, plaque control record and community periodontal treatment needs indices were evaluated. RESULTS: Children with IBD compared with controls had a statistically significant (P < 0.001) higher dmf-t (2.95 versus 0.91) or DMF-T (5.81 versus 2.04) index and a higher gingival inflammation (simplified gingival, 40% versus 24%) although the respectively dental plaque index showed no significant difference (plaque control record, 42% versus 41%). Also, the community periodontal treatment needs was significantly higher compared with controls (P < 0.001); most of the patients with IBD needed treatment of gingivitis (47% versus 4%), and none of them had healthy periodontium (0% versus 69%). CONCLUSIONS: The results of this case-control study demonstrate a higher frequency of dental caries, more clinical signs of gingival inflammation, and increased periodontal treatment needs in children and adolescents with IBD despite similar oral hygiene status.

Pediatric inflammatory bowel disease in Greece: 30-years experience of a single center.

BACKGROUND: Significant advances have been made in the care of children with inflammatory bowel disease (IBD). We aimed to describe the trends during the last 3 decades in the clinical presentation, management, and outcome of pediatric IBD at a single center. METHODS: Medical records of children with IBD referred to a pediatric gastroenterology unit from January 1981 to December 2011 were reviewed retrospectively. RESULTS: A total of 483 children were diagnosed with IBD, with mean age at diagnosis of 9.6 years (range 6 months - 18 years). Ulcerative colitis (UC) was diagnosed in 267 (55.2%), Crohn's disease (CD) in 167 (34.5%), and IBD unclassified (IBDU) in 49 (10.1%). Children with UC and IBDU were younger than those with CD [mean age at diagnosis 9.2, 8.9, and 10.5 years respectively; P (UC vs. CD)<0.01 and P (IBDU vs. CD)=0.028]. Patients received 5-ASA (96.6%), steroids (77.0%), thiopurines (50.2%), biological agents (14%), and 10% underwent surgical intervention. The cohort was divided into three subgroups according to the date of diagnosis; Group A: 1981-1989, Group B: 1990-1999, and Group C: 2000-2011. During the last two decades a significant increase in CD (Group A 18.5%, Group B 23.8%, Group C 48.8%; P<0.01) compared with the first decade with parallel decrease in UC (Group A 79.6%, Group B 71.9%, Group C 33.2%; P<0.001) was observed. CONCLUSIONS: Most children received 5-ASA, steroids, and immunomodulators. Patients with UC and IBDU were younger than those with CD. A significant increase in CD with parallel decrease in UC during the last decade was found.

Investigative MRI cholangiopancreatography for primary sclerosing cholangitis-type lesions in children with IBD.

OBJECTIVES: The aim of the study was to estimate the frequency of primary sclerosing cholangitis (PSC)-type lesions in children with inflammatory bowel disease (IBD) by means of magnetic resonance cholangiopancreatography (MRCP), and to investigate the association between a series of easily applicable data on the one hand and the presentation of such lesions at MRCP on the other hand. METHODS: Collected demographic, laboratory, and magnetic resonance enterography data from the records of 73 children with IBD were cross-sectionally related to the MRCP-based diagnosis. RESULTS: Around the time of MRCP, the distribution of IBD subtypes was 64.4%, 24.7%, and 11% for Crohn disease, indeterminate colitis, and ulcerative colitis, respectively. A total of 11 patients (15.1%) were identified with PSC-type lesions. Demographic and magnetic resonance enterography data were unrelated to the MRCP outcome. Biochemical abnormalities were of low prevalence (<50%) among patients with PSC. The abnormality prevalences of aspartate transaminase, alanine transaminase, and γ-glutamyl transferase were significantly higher in the PSC group, both at initial diagnosis of IBD and at the time of MRCP. Less-consistent results were documented for bilirubin and alkaline phosphatase, especially at initial diagnosis of IBD. CONCLUSIONS: The abnormality prevalences of aspartate transaminase, alanine transaminase, and γ-glutamyl transferase were significantly higher in the PSC group. Nevertheless, PSC-type lesions frequently occur in pediatric IBD, even if the biochemical profile is hardly indicative of this probability.