Histopathological changes in anatomical distribution of inflammatory bowel disease in children: a retrospective cohort study

In a retrospective cohort study, the medical records of children with inflammatory bowel disease were examined. Patients who had at least 2 endoscopic/colonoscopic examinations were included. Primary outcome was histopathological progression based on histopathological examination of biopsies taken during endoscopic and colonoscopic bowel examination. Factors predictive of disease progression were also examined.A total of 98 patients fulfilled inclusion criteria (49 female, 54 with ulcerative colitis, range 2 – 17 years, mean age at diagnosis was 10.6 years, SD ± 3.67), the mean duration of follow up was 32.9 months (range 0.1 – 60 months, SD ± 8.54). In the ulcerative colitis group, 41% had disease progression and none of the examined variables (age, gender, laboratory markers, growth and disease activity at diagnosis) appeared to effect disease progression. In the Crohn’s disease group, 75% had disease progression. Girls (OR = 0.13, 95% CI 0.02 – 0.79) and patients with high erythrocytic sedimentation rate (OR=0.942, 95% CI 0.894 – 0.99) were predictive for disease progression.Despite maximum therapy, the majority of children with Crohn’s disease appeared to have histopathological disease progression. Female sex and high erythrocytic sedimentation rate seemed to be predictive for disease progression. None of the factors analyzed seemed predictive of disease progression in ulcerative colitis.Inflammatory bowel diseases (IBD), mainly ulcerative colitis and Crohn’s disease are chronic, lifelong illnesses with young age of onset and a great potential for morbidity. The incidence of inflammatory bowel disease in the pediatric population is increasing [1,2]. About 20% of patients with IBD present before the age of 18 years old [1-7]. The natural history of these diseases is influenced by multiple factors of environmental and genetic origin. IBD showing colonic involvement has been reported to be more frequent in younger children when compared to older children [5]. Child