Carvalho Ryan S, Abadom Vivian, Dilworth Harrison P, Thompson Richard, Oliva-Hemker Maria, Cuffari Carmen
Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Baltimore, MD 21287, USA.
Inflamm Bowel Dis. 2006 Apr;12(4):258-62. doi: 10.1097/01.MIB.0000215093.62245.b9.
Indeterminate colitis (IC) is a subgroup of inflammatory bowel disease (IBD) that cannot be characterized as either ulcerative colitis (UC) or Crohn's disease (CD). Our aims are to determine the prevalence of IC in our pediatric patient population and to describe its clinical presentation, natural history,and disease distribution.
We performed a retrospective database analysis of all children diagnosed with IBD at the Johns Hopkins Children's IBD Center between 1996 and 2001. Patient demographics, including age, sex, and age at disease onset, were tallied. Disease distribution was identified on the basis of a review of all endoscopic, colonoscopic, histopathological, and radiological records. All of the patients were followed up clinically to determine the extent of disease progression on the basis of the initial diagnosis of IC.
Among 250 children registered in the database, 127 (50.8%) had a diagnosis of CD, 49 (19.6%) had UC, and 74(29.6%) had IC. Patients with IC had a significantly younger mean +/- SEM age (9.53 +/- 4.8 years) at diagnosis compared with patients with CD (12.4 +/- 3.8 years; P < 0.001) but not compared with patients with UC (7.41 +/- 3.5 years). Among the patients with IC, 59 (79.7%) had a pancolitis at diagnosis, and the remaining 15 had left-sided disease that progressed to a pancolitis within a mean of 6 years. Twenty-five patients (33.7%) with an initial diagnosis of IC were reclassified to either CD or UC after a median follow-up of 1.9 years (range 0.6-4.5 years). Forty-nine patients (66.2%) maintained their diagnosis of IC after a mean follow-up of 7 years (SEM 2.5 years).
IC is a distinct pediatric subgroup of IBD with a prevalence that is higher than that observed in adults. Children with IC have an early age of disease onset and a disease that rapidly progresses to pancolitis. Longitudinal studies are needed to determine the clinical implications of this pediatric IBD subgroup.
不确定性结肠炎（IC）是炎症性肠病（IBD）的一个亚组，其无法被归类为溃疡性结肠炎（UC）或克罗恩病（CD）。我们的目的是确定儿科患者群体中IC的患病率，并描述其临床表现、自然病程和疾病分布。
我们对1996年至2001年间在约翰霍普金斯儿童IBD中心被诊断为IBD的所有儿童进行了回顾性数据库分析。统计患者的人口统计学数据，包括年龄、性别和发病年龄。根据对所有内镜、结肠镜、组织病理学和放射学记录的审查确定疾病分布。对所有患者进行临床随访，以根据IC的初始诊断确定疾病进展程度。
在数据库登记的250名儿童中，127名（50.8%）被诊断为CD，49名（19.6%）患有UC，74名（29.6%）患有IC。与CD患者（12.4±3.8岁；P<0.001）相比，IC患者诊断时的平均年龄±标准误显著更小（9.53±4.8岁），但与UC患者（7.41±3.5岁）相比无差异。在IC患者中，59名（79.7%）诊断时为全结肠炎，其余15名患有左侧疾病，平均在6年内进展为全结肠炎。在中位随访1.9年（范围0.6 - 4.5年）后，25名初始诊断为IC的患者（33.7%）被重新分类为CD或UC。在平均随访7年（标准误2.5年）后，49名患者（66.2%）维持IC诊断。
IC是IBD中一个独特的儿科亚组，其患病率高于成人。患有IC的儿童发病年龄早，疾病迅速进展为全结肠炎。需要进行纵向研究以确定这个儿科IBD亚组的临床意义。
