The following is a summary of “Clinical Course of Very Early-Onset Inflammatory Bowel Disease,” published in the May 2023 issue of Pediatrics by Cucinotta, et al.
For a study, researchers sought to describe the clinical features, outcomes, and treatment response of very early-onset inflammatory bowel disease (VEO-IBD) patients and compare them with pediatric inflammatory bowel disease (P-IBD) patients with later-onset.
Consecutive patients aged 0-6 years diagnosed with Crohn’s disease (CD), ulcerative colitis, or indeterminate colitis (IBD-U) at two academic hospitals were included between 2010 and March 2021. They were compared to sex-matched P-IBD patients aged 6-17 years.
A total of 232 patients were included, with 78 (34%) in the VEO-IBD group and 154 (66%) in the P-IBD group. IBD-U was the most common diagnosis in the VEO-IBD group compared to P-IBD (28% vs. 3%, P < 0.001), while CD was more predominant in older children (27% vs. 52%, P < 0.001). The VEO-IBD group had lower rates of clinical remission after induction with steroids compared to older children (82% vs. 93%, P = 0.01), higher rates of steroid resistance (14% vs 5%, P = 0.02), and steroid dependence (27% vs 8%, P < 0.001). The number of patients initiating anti-tumor necrosis factor (TNF)-α agents was similar between the groups. However, anti-TNF-α retention was lower in the VEO-IBD group at 1 and 2 years (59% vs 85%, P = 0.003; 16% vs 55%, P < 0.001, respectively). The VEO-IBD group also had a higher surgical risk than P-IBD (32% vs 14%, P < 0.001).
Patients with VEO-IBD may have a more severe disease course, a poorer response to steroids and anti-TNF-α agents, and a higher likelihood of requiring surgical procedures than P-IBD patients. The findings highlighted the distinct characteristics and challenges associated with VEO-IBD.