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Open Access Research article

Histopathological changes in anatomical distribution of inflammatory bowel disease in children: a retrospective cohort study

Jessica Tsang2, Sheena Sikora2, Donald Spady3 and Wael El-Matary1*

Author affiliations

1 Section of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

2 Faculty of Medicine, University of Alberta, Edmonton, Canada

3 Department of Pediatric Epidemiology and Research, Faculty of Medicine, University of Alberta, Edmonton, Canada

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Citation and License

BMC Pediatrics 2012, 12:162  doi:10.1186/1471-2431-12-162

Published: 13 October 2012

Abstract

Background

Anatomical progression of pediatric inflammatory bowel disease is under-reported. The aim of this work was to examine possible changes in the anatomical distribution of IBD in pediatric patients at diagnosis and at follow up.

Methods

In a retrospective cohort study, the medical records of children with inflammatory bowel disease were examined. Patients who had at least 2 endoscopic/colonoscopic examinations were included. Primary outcome was histopathological progression based on histopathological examination of biopsies taken during endoscopic and colonoscopic bowel examination. Factors predictive of disease progression were also examined.

Results

A total of 98 patients fulfilled inclusion criteria (49 female, 54 with ulcerative colitis, range 2 – 17 years, mean age at diagnosis was 10.6 years, SD ± 3.67), the mean duration of follow up was 32.9 months (range 0.1 – 60 months, SD ± 8.54). In the ulcerative colitis group, 41% had disease progression and none of the examined variables (age, gender, laboratory markers, growth and disease activity at diagnosis) appeared to effect disease progression. In the Crohn’s disease group, 75% had disease progression. Girls (OR = 0.13, 95% CI 0.02 – 0.79) and patients with high erythrocytic sedimentation rate (OR=0.942, 95% CI 0.894 – 0.99) were predictive for disease progression.

Conclusions

Despite maximum therapy, the majority of children with Crohn’s disease appeared to have histopathological disease progression. Female sex and high erythrocytic sedimentation rate seemed to be predictive for disease progression. None of the factors analyzed seemed predictive of disease progression in ulcerative colitis.

Keywords:
IBD; Crohn’s; Ulcerative colitis; Children