Paediatric inflammatory bowel disease: Clinical presentation and disease location

Objective: To determine different clinical presentations and disease location demarcated by upper and lower gastrointestinal endoscopy and relevant histopathology in children diagnosed with inflammatory bowel disease (IBD).

Methods: This is 5 years (2010 to 2015) retrospective study conducted at the Aga Khan University Hospital enrolling 65 admitted children between 6 months to 15 years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by paediatric gastroenterologists at endoscopy suite of the hospital and all specimens were reported by the pathology department. ESPGHAN revised criteria for the diagnosis of inflammatory bowel disease in children and an adolescent was used to standardize our diagnosis. Extent of disease on endoscopy and relevant histopathology of the biopsy samples were noted at the time of diagnosis. Data was summarized using mean, standard deviation, numbers and percentages for different variables.

Results: Total 56 children were enrolled according to inclusion criteria. There were 34 children (61.53%) diagnosed with ulcerative colitis (UC), 10 patients (16.92%) had Crohn’s Disease (CD) and 11 (21.53%) patients were labeled as Indeterminate colitis (IC). Mean age at onset of symptoms was10.03±2.44 and mean age at diagnosis was11.10±2.36. Abdominal pain (80%) and chronic diarrhea (70%) were common symptoms in CD whereas bloody diarrhea (79.41%) and rectal bleeding (64.70%) were common presentation in UC. Patients diagnosed with indeterminate colitis(IC) had similar clinical features as in UC patients. Only 7% patients had some extra-intestinal features in the form of joint pain and /or uveitis. Aspartate aminotransferase level (95.18 ±12.89) was relatively high in patients with CD in comparison with other categories of IBD. Endoscopic findings and relevant histopathology of biopsy samples in UC showed 65% patient had pan-colitis and 13% with disease restricted to rectum only whereas in CD 70% patient had disease in ileo-colon and only 10% had involvement of ileum at the time diagnosis.

Conclusion: Patients with UC dominated in our cohort. The most common clinical presentation in UC was bloody diarrhea and rectal bleeding and patients with CD had abdominal pain and chronic diarrhea as predominant clinical features. Extraintestinal features were uncommon in our cohort. In endoscopic findings, pan-colitis was the most frequent finding in UC and ileo-colon was common location in CD. IC and UC shared common clinical features and disease location on endoscopy.