Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment

Thomas Greuter, Fabio Bertoldo, Roman Rechner, Alex Straumann, Luc Biedermann, Jonas Zeitz, Benjamin Misselwitz, Michael Scharl, Gerhard Rogler, Ekaterina Safroneeva, Raja Affendi Raja Ali, Christian Braegger, Klaas Heyland, Pascal Mueller, Andreas Nydegger, Laetitia Marie Petit, Susanne Schibli, Raoul I. Furlano, Johannes Spalinger, Michela SchäppiSamuel Zamora, Florian Froehlich, Denise Herzog, Alain M. Schoepfer, Stephan R. Vavricka

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). Methods: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. Results: A total of 55 patients (16.7%) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5% vs 10.3%, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4%) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4% vs 35.0%, P = 0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%). Conclusions: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.

Original languageEnglish
Pages (from-to)200-206
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume65
Issue number2
DOIs
Publication statusPublished - 1 Aug 2017

Fingerprint

Inflammatory Bowel Diseases
Tumor Necrosis Factor-alpha
Pediatrics
Therapeutics
Ulcerative Colitis
Crohn Disease
Arthritis
Aphthous Stomatitis
Uveitis
Switzerland
Population
Cohort Studies

Keywords

  • anti-tumor necrosis factor
  • arthritis
  • extraintestinal manifestations
  • inflammatory bowel disease
  • uveitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease : Prevalence, Presentation, and Anti-TNF Treatment. / Greuter, Thomas; Bertoldo, Fabio; Rechner, Roman; Straumann, Alex; Biedermann, Luc; Zeitz, Jonas; Misselwitz, Benjamin; Scharl, Michael; Rogler, Gerhard; Safroneeva, Ekaterina; Raja Ali, Raja Affendi; Braegger, Christian; Heyland, Klaas; Mueller, Pascal; Nydegger, Andreas; Petit, Laetitia Marie; Schibli, Susanne; Furlano, Raoul I.; Spalinger, Johannes; Schäppi, Michela; Zamora, Samuel; Froehlich, Florian; Herzog, Denise; Schoepfer, Alain M.; Vavricka, Stephan R.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 65, No. 2, 01.08.2017, p. 200-206.

Research output: Contribution to journalArticle

Greuter, T, Bertoldo, F, Rechner, R, Straumann, A, Biedermann, L, Zeitz, J, Misselwitz, B, Scharl, M, Rogler, G, Safroneeva, E, Raja Ali, RA, Braegger, C, Heyland, K, Mueller, P, Nydegger, A, Petit, LM, Schibli, S, Furlano, RI, Spalinger, J, Schäppi, M, Zamora, S, Froehlich, F, Herzog, D, Schoepfer, AM & Vavricka, SR 2017, 'Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment', Journal of Pediatric Gastroenterology and Nutrition, vol. 65, no. 2, pp. 200-206. https://doi.org/10.1097/MPG.0000000000001455
Greuter, Thomas ; Bertoldo, Fabio ; Rechner, Roman ; Straumann, Alex ; Biedermann, Luc ; Zeitz, Jonas ; Misselwitz, Benjamin ; Scharl, Michael ; Rogler, Gerhard ; Safroneeva, Ekaterina ; Raja Ali, Raja Affendi ; Braegger, Christian ; Heyland, Klaas ; Mueller, Pascal ; Nydegger, Andreas ; Petit, Laetitia Marie ; Schibli, Susanne ; Furlano, Raoul I. ; Spalinger, Johannes ; Schäppi, Michela ; Zamora, Samuel ; Froehlich, Florian ; Herzog, Denise ; Schoepfer, Alain M. ; Vavricka, Stephan R. / Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease : Prevalence, Presentation, and Anti-TNF Treatment. In: Journal of Pediatric Gastroenterology and Nutrition. 2017 ; Vol. 65, No. 2. pp. 200-206.
@article{0ab47efd7d2a453781a165fbe97025bb,
title = "Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment",
abstract = "Background: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). Methods: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. Results: A total of 55 patients (16.7{\%}) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5{\%} vs 5.0{\%}, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5{\%} vs 10.3{\%}, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9{\%}) and aphthous stomatitis (24/329, 7.3{\%}). Approximately 27.6{\%} of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4{\%}) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4{\%} vs 35.0{\%}, P = 0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5{\%}) and uveitis (66.7{\%}). Conclusions: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30{\%}, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.",
keywords = "anti-tumor necrosis factor, arthritis, extraintestinal manifestations, inflammatory bowel disease, uveitis",
author = "Thomas Greuter and Fabio Bertoldo and Roman Rechner and Alex Straumann and Luc Biedermann and Jonas Zeitz and Benjamin Misselwitz and Michael Scharl and Gerhard Rogler and Ekaterina Safroneeva and {Raja Ali}, {Raja Affendi} and Christian Braegger and Klaas Heyland and Pascal Mueller and Andreas Nydegger and Petit, {Laetitia Marie} and Susanne Schibli and Furlano, {Raoul I.} and Johannes Spalinger and Michela Sch{\"a}ppi and Samuel Zamora and Florian Froehlich and Denise Herzog and Schoepfer, {Alain M.} and Vavricka, {Stephan R.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1097/MPG.0000000000001455",
language = "English",
volume = "65",
pages = "200--206",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease

T2 - Prevalence, Presentation, and Anti-TNF Treatment

AU - Greuter, Thomas

AU - Bertoldo, Fabio

AU - Rechner, Roman

AU - Straumann, Alex

AU - Biedermann, Luc

AU - Zeitz, Jonas

AU - Misselwitz, Benjamin

AU - Scharl, Michael

AU - Rogler, Gerhard

AU - Safroneeva, Ekaterina

AU - Raja Ali, Raja Affendi

AU - Braegger, Christian

AU - Heyland, Klaas

AU - Mueller, Pascal

AU - Nydegger, Andreas

AU - Petit, Laetitia Marie

AU - Schibli, Susanne

AU - Furlano, Raoul I.

AU - Spalinger, Johannes

AU - Schäppi, Michela

AU - Zamora, Samuel

AU - Froehlich, Florian

AU - Herzog, Denise

AU - Schoepfer, Alain M.

AU - Vavricka, Stephan R.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). Methods: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. Results: A total of 55 patients (16.7%) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5% vs 10.3%, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4%) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4% vs 35.0%, P = 0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%). Conclusions: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.

AB - Background: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). Methods: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. Results: A total of 55 patients (16.7%) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5% vs 10.3%, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4%) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4% vs 35.0%, P = 0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%). Conclusions: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.

KW - anti-tumor necrosis factor

KW - arthritis

KW - extraintestinal manifestations

KW - inflammatory bowel disease

KW - uveitis

UR - http://www.scopus.com/inward/record.url?scp=84994067458&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994067458&partnerID=8YFLogxK

U2 - 10.1097/MPG.0000000000001455

DO - 10.1097/MPG.0000000000001455

M3 - Article

C2 - 27801751

AN - SCOPUS:84994067458

VL - 65

SP - 200

EP - 206

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

SN - 0277-2116

IS - 2

ER -