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Aliment Pharmacol Ther. 2019 Feb;49(4):419-428. doi: 10.1111/apt.15114. Epub 2019 Jan 13.

Differences between childhood- and adulthood-onset inflammatory bowel disease: the CAROUSEL study from GETECCU.

Author information

1
Gastroenterology Unit, Instituto de Investigación Sanitaria Princesa (IIS-IP) and CIBERehd, Hospital Universitario de La Princesa, Madrid, Spain.
2
Gastroenterology Unit and CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain.
3
Gastroenterology Unit and IMIBIC, Hospital Reina Sofía, Córdoba, Spain.
4
Gastroenterology Unit, Hospital Clínico San Carlos, Madrid, Spain.
5
Gastroenterology Unit and CIBERehd, Hospital Universitario Germans Trias i Pujol, Badalona, Spain.

Abstract

BACKGROUND:

Cohort studies comparing the characteristics of childhood-onset and adulthood-onset inflammatory bowel disease (IBD) in the biologics era are scarce.

AIM:

To compare disease characteristics, the use of immunomodulators and biologic agents and the need for surgery between childhood- and adulthood-onset IBD.

METHODS:

Inflammatory bowel disease patients from the ENEIDA registry diagnosed between 2007 and 2017 were included. The childhood-onset cohort comprised patients diagnosed at ≤16 years of age and the adulthood-onset cohort those diagnosed at >16 years. The cumulative incidences of immunosuppressive therapy, biologic therapy and surgery were estimated using Kaplan-Meier curves, compared by the log-rank test. Cox regression analysis was performed to identify potential predictive factors of treatment with immunosuppressants, biologic agents or surgery.

RESULTS:

The adulthood-onset cohort comprised 21 200 patients out of 20 354 (96%) and the childhood-onset cohort 846 (4%). Median follow-up was 54 months in the childhood-onset cohort and 38 months in the adulthood-onset cohort (P < 0.01). Proportions of Crohn's disease, ileocolonic involvement and inflammatory behaviour at diagnosis were higher in the childhood-onset cohort. In the multivariate analysis, after adjusting for sex, type of IBD, extraintestinal manifestations, family history and smoking habit, childhood-onset IBD was associated with higher risk of immunomodulator use (hazard ratio [HR] = 1.2, 95% confidence interval [95% CI] = 1.1-1.2) and higher probability of receiving biologic treatment (HR = 1.2, 95% CI = 1.1-1.3). However, childhood-onset IBD was not associated with higher risk of surgery (HR = 0.9, 95% CI = 0.8-1.2).

CONCLUSIONS:

Childhood-onset IBD has differential characteristics and higher risk of treatment with immunomodulators and biologic agents, compared with adulthood-onset IBD. Nevertheless, paediatric IBD is not associated with higher risk of surgery.

PMID:
30637837
DOI:
10.1111/apt.15114

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