Malaty Hoda M, Mehta Seema, Abraham Bincy, Garnett Elizabeth A, Ferry George D
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Clin Exp Gastroenterol. 2013 Jul 23;6:115-21. doi: 10.2147/CEG.S44700. Print 2013.
Inflammatory bowel disease (IBD)-indeterminate is a subgroup of IBD that has features of both ulcerative colitis (UC) and Crohn's disease (CD).
To determine the clinical course of IBD-indeterminate in children over a 25 year period.
We performed a retrospective investigation on children diagnosed with IBD. Diagnosis and disease distribution of IBD was based on clinical, radiologic, endoscopic, and histologic examinations.
Four hundred and twenty children diagnosed with IBD between 1986 and 2003 were identified from the IBD registry, 78 (22%) of whom were diagnosed with IBD-indeterminate. The mean age at diagnosis was 9.2 ± 4 years and the mean follow-up period was 4.1 ± 2 years. In 2003, 18 of 78 children (23%) were reclassified by the same physician based on the endoscopic and pathologic findings as follows: eight children with CD, five children with UC, and five children with non-IBD (eg, eosinophilic colitis). During 2011, 20 of the 60 patients who had maintained an IBD-indeterminate diagnosis were located and contacted, and detailed telephone interviews were conducted by the corresponding author. Two patients were reclassified as having CD (10%), one patient was reclassified as having eosinophilic colitis (5%), six patients remained with IBD-indeterminate (30%), and eleven patients (55%) reported a complete resolution of their symptoms. The follow-up period ranged from 10-18 years (mean 12.5 ± 3 years). Children who were reclassified as having CD were significantly younger than those who maintained an IBD-indeterminate diagnosis (6.4 ± 4 years versus11.2 ± 3 years, respectively, P = 0.05).
Children with IBD-indeterminate remain classified as IBD-indeterminate, or were clinically reclassified as CD or non-IBD, or became asymptomatic as they transitioned into adulthood. The need for IBD-indeterminate classification is of importance, especially when deciding on management and treatment.
炎症性肠病（IBD）-不确定性是IBD的一个亚组，具有溃疡性结肠炎（UC）和克罗恩病（CD）的特征。
确定25年间儿童IBD-不确定性的临床病程。
我们对诊断为IBD的儿童进行了一项回顾性调查。IBD的诊断和疾病分布基于临床、放射学、内镜和组织学检查。
从IBD登记处识别出1986年至2003年间诊断为IBD的420名儿童，其中78名（22%）被诊断为IBD-不确定性。诊断时的平均年龄为9.2±4岁，平均随访期为4.1±2年。2003年，同一位医生根据内镜和病理检查结果将78名儿童中的18名（23%）重新分类如下：8名儿童为CD，5名儿童为UC，5名儿童为非IBD（如嗜酸性结肠炎）。2011年，找到并联系了保持IBD-不确定性诊断的60名患者中的20名，并由通讯作者进行了详细的电话访谈。2名患者被重新分类为患有CD（10%），1名患者被重新分类为患有嗜酸性结肠炎（5%），6名患者仍为IBD-不确定性（30%），11名患者（55%）报告症状完全缓解。随访期为10至18年（平均12.5±3年）。重新分类为患有CD的儿童明显比保持IBD-不确定性诊断的儿童年轻（分别为6.4±4岁和11.2±3岁，P = 0.05）。
IBD-不确定性儿童在过渡到成年期时，仍被分类为IBD-不确定性，或在临床上被重新分类为CD或非IBD，或无症状。IBD-不确定性分类的必要性很重要，尤其是在决定管理和治疗时。
