[Intestinal complications and extraintestinal manifestations in children with inflammatory bowel disease]

Andrzej Stawarski, Barbara Iwańczak, Elzbieta Krzesiek, Franciszek Iwańczak
Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego 2006, 20 (115): 22-5

UNLABELLED: In 15-20% of patients with inflammatory bowel disease (IBD) the disease starts during children period. The often observed consequences of the early start of the IBD are growth delay, undernutrition and pubertal delay. These problems are specific for pediatric population, in comparison with adults IBD patients.

AIM: The assessment of the frequency and character of intestinal complications (IC) and extraintestinal manifestations (ElM) in children with IBD (ulcerative colitis - UC and Crohn disease - CD).

MATERIAL AND METHODS: The frequency and character of IC and EIM in 184 children with IBD: 158 with UC (76 boys and 82 girls) aged from 2 to 18 years, and 26 with CD (14 boys and 12 girls) aged from 2 to 18 years were assessed. The frequency of IC and EIM in both groups of children Was compared statistically (chi-square test).

RESULTS: Massive intestinal haemorrhage was observed in 11 children with UC. Perianal changes were present in 5 children with CD (significantly more often than in children with UC, p<0.05). External intestinal fistulae (p<0.0005), abdominal abscess, intestinal perforation and ileus (p<0.05) were characteristic complications of CD in comparison with UC. 50% of children with UC and 80% those with CD (statistically significant, p<0.005) had experienced, at least one ElM. Secondary anemia and growth delay were observed in 40,5% and 27,8% of children with UC and in 70% (p<0.05) and 80% (p<0.0001) of children with CD respectively. In children with IBD we observed also autoimmunologic hepatitis, primary sclerosing cholangitis, nephrolithiasis, pulmonary interstitial fibrosis, pancreatitis, neurological changes, skin manifestations and arthritis. Osteopenia was observed in 41% of children with CD and in 25% of children with UC. a

CONCLUSIONS: A high prevalence of intestinal complications ane extraintestinal manifestations of IBD in pediatric population is observed. In children with IBD extraintestinal manifestations often occur before the onset of gastrointestinal symptoms. The presence of intestinal complications and extraintestinal manifestations in children with IBD should be considered during modification of therapeutic strategies.

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