Herzog Denise, Fournier Nicolas, Buehr Patrick, Rueger Vanessa, Koller Rebekka, Heyland Klaas, Nydegger Andreas, Spalinger Johannes, Schibli Susanne, Petit Laetitia-Marie, Braegger Christian P
Department of Paediatrics, Division of Gastroenterology, Cantons Hospital of Fribourg, Fribourg.
Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, University of Lausanne.
Eur J Gastroenterol Hepatol. 2018 Jun;30(6):598-607. doi: 10.1097/MEG.0000000000001072.
A small but increasing number of patients with inflammatory bowel disease are diagnosed during childhood or adolescence, and disease distribution and severity at onset vary according to the age at diagnosis. Clinical factors present at the time of diagnosis can be predictive of the disease course.
The aim of this study was to characterize disease behavior and the cumulative complications and extraintestinal manifestations 10 years after the diagnosis and to assess their association with age at diagnosis.
Data of patients participating with the Swiss IBD cohort study registry, a disease duration of 10 years and a complete data set were analyzed. The outcome was defined as the cumulative change of disease behavior, the occurrence of extra-intestinal manifestations or complications, and the necessity for medical or surgical interventions.
A total of 481 patients with Crohn's disease (CD) and 386 patients with ulcerative colitis (UC), grouped according to disease onset before 10, 17, 40, or after 40 years of age, were analyzed. Despite differences in sex, initial disease location, and smoking habits, at 10 years after the diagnosis, no difference was found regarding disease behavior in CD or regarding progression of disease extension in UC. Similarly, no age-of-onset-dependent cumulative need for medical or surgical therapies was found. However, higher rates of anemia and lower rates of arthralgia and osteopenia were found in both pediatric-onset CD and UC, and a tendency toward higher rates of stomatitis in pediatric-onset CD, and of primary sclerosing cholangitis and ankylosing spondylitis in pediatric-onset UC.
After 10 years of disease evolution, age at disease onset is not anymore associated with disease behavior but only with a small difference in the occurrence of specific extraintestinal manifestations and complications.
一小部分但数量不断增加的炎症性肠病患者在儿童期或青春期被诊断出来，疾病的分布和发病时的严重程度因诊断年龄而异。诊断时出现的临床因素可预测疾病进程。
本研究的目的是描述诊断10年后的疾病行为、累积并发症和肠外表现，并评估它们与诊断年龄的关联。
分析了参与瑞士炎症性肠病队列研究登记处、病程为10年且数据集完整的患者数据。结局定义为疾病行为的累积变化、肠外表现或并发症的发生以及医疗或手术干预的必要性。
共分析了481例克罗恩病（CD）患者和386例溃疡性结肠炎（UC）患者，根据发病年龄在10岁、17岁、40岁之前或40岁之后进行分组。尽管在性别、初始疾病部位和吸烟习惯方面存在差异，但在诊断10年后，CD的疾病行为或UC的疾病扩展进展方面未发现差异。同样，未发现发病年龄依赖性的医疗或手术治疗累积需求。然而，儿童期发病的CD和UC中贫血发生率较高，关节痛和骨质减少发生率较低，儿童期发病的CD中口腔炎发生率有升高趋势，儿童期发病的UC中原发性硬化性胆管炎和强直性脊柱炎发生率有升高趋势。
疾病发展10年后，发病年龄与疾病行为不再相关，仅与特定肠外表现和并发症的发生存在微小差异有关。
