Editor’s Note: Abby Temple (she/her/hers) is a resident physician in the Boston Combined Residency Program. She is interested in the integration of advocacy and health equity research into undergraduate medical education. Abby is interested in pursuing a fellowship specializing in gastroenterology or critical care. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Approximately 10% of all patients with inflammatory bowel disease (IBD) cases are diagnosed during childhood. Of these, a unique subset experiences onset before 6 years of age (very early onset IBD [VEOIBD]).
This group of patients has had varied outcomes, with some prior studies reporting more favorable outcomes compared with older children diagnosed with IBD and others reporting worse outcomes, including more severe disease.
In an article being early released this week in Pediatrics, Dr. Anat Guz-Mark and colleagues from the Porto IBD working group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) studied 243 patients from multiple countries to further describe the clinical characteristics and long-term outcomes of both infantile (onset before 2 years of age) and non-infantile (onset between 2 and 6 years of age) VEOIBD (10.1542/peds.2023-064546).
The authors found that children diagnosed with VEOIBD had fair long-term outcomes with:
- Lower rates of increased disease severity
- Lower rates of increased medication requirement to reach remission
- Lower rates of surgical intervention
- Normal growth
Additionally, while patients with infantile VOEIBD had more severe initial presentations and lower response to initial therapy than their older counterparts, there was no difference between the two groups in long-term outcomes or rates of complications.
While there was minimal difference in outcomes between age groups, there were differences in outcomes between children with monogenic (controlled by a single gene change) and non-monogenic (controlled by multiple genes or unidentifiable genes) disease. Children with monogenic VEOIBD had higher rates of initial treatment failure, higher rates of severe infection, and more surgical interventions.
While age at diagnosis seems to play less of a role in determining prognosis, more widespread genetic testing could lend more prognostic information due to the increased severity of disease noted in monogenic VEOIBD.
