Open AccessExtraintestinal Manifestations of Pediatric Inflammatory Bowel Disease
Author(s) -
Greuter Thomas,
Bertoldo Fabio,
Rechner Roman,
Straumann Alex,
Biedermann Luc,
Zeitz Jonas,
Misselwitz Benjamin,
Scharl Michael,
Rogler Gerhard,
Safroneeva Ekaterina,
Ali Raja A.R.,
Braegger Christian,
Heyland Klaas,
Mueller Pascal,
Nydegger Andreas,
Petit LaetitiaMarie,
Schibli Susanne,
Furlano Raoul I.,
Spalinger Johannes,
Schäppi Michela,
Zamora Samuel,
Froehlich Florian,
Herzog Denise,
Schoepfer Alain M.,
Vavricka Stephan R.
Publication year - 2017
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000001455
Subject(s) - medicine , ulcerative colitis , inflammatory bowel disease , gastroenterology , cohort , population , disease , crohn's disease , immunology , environmental health
Background: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). Methods: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. Results: A total of 55 patients (16.7%) experienced 1–4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD‐unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD‐unclassified (22.5% vs 10.3%, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (−37.5–149.0). Thirty‐one of the 55 patients (56.4%) were treated with 1 or more anti–tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti‐TNF compared to those without (56.4% vs 35.0%, P = 0.003). Response rates to anti‐TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%). Conclusions: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti‐TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti‐TNF therapy.