Observational Study
Copyright ©The Author(s) 2016.
World J Gastroenterol. Dec 28, 2016; 22(48): 10653-10662
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10653
Table 1 Phenotypic characteristics, disease behavior, therapy and outcome in six Asian children with infantile-onset inflammatory bowel disease
Patients’ initialsNo. 1No. 2No. 3No. 4No. 5No. 6
Breast feeding (duration)NoNoNoYes (3 mo)Yes (2 mo)Yes (4 mo)
Age at onsetFirst week12 mo7 mo2 mo6 mo4 mo
Disease phenotypeEC→UCUCCDCDCDIBD-U
Major symptoms at presentationBloody diarrhea and PR bleedingBloody diarrhea, anemiaOral ulcers, bloody diarrhea, abdominal painBloody diarrhea, abdominal painBloody diarrhea, growth falteringBloody diarrhea
Perianal diseaseNilNilAbscess and fistulaAbscess and fistulaNilAbscess and fistula
Other medical or autoimmune conditionsNilNilNilNilNilNil
Recurrent infectionsNilNilCongenital CMV infection,NilNilNil
Disease location1E4S1E4L3L4aL3L4aL3L2
Disease behavior/severity1S1S1B2B3pB2B3pB1B1p
HistopathologyDense lymphoplasmacytic and eosinophilic infiltration of the lamina propria involving the gastric mucosa, duodenum and colonic mucosa.Colonic mucosa showed mild degenerative atypia, cryptitis and crypt abscesses. Lamina propria showed increase in neutrophilic and lymphoplasmacytic infiltration.Lymphocytic infiltration of lamina propria. No granuloma or crypt abscess seen. The duodenum showed chronic inflammation.Lymphocytic infiltration of lamina propria. No granuloma or crypt abscess seenMild inflammation in the lamina propria with lymphocytes and plasma cells. No granuloma or crypt abscessFirst biopsy: transmural inflammation involving all layers of bowel wall, including the skeletal muscle with dense lymphoplasmacytic infiltration. No crypt abscess seen.
Second biopsy: colonic mucosa inflammed but the architecture was preserved. Significant lymphoplasmacytic and neutrophilic infiltration mainly confined to the lamina propria
Other associated diseasesNilNilDevelopmental regression at 6 yr ageNilNilNil
Mutational analysisNot doneNot doneNot detectedNot detectedNot detectedNot detected
Medical therapyCS, CsA, enteral nutritionCS, AzaCS, Aza, IFX × 24 dosesEN, CS, Aza, IFX × 14 dosesAza, IFX × 3 dosesNil
SurgeryTotal colectomy at 18 moNilIleostomy at 6 yr of ageNilNilIleostomy; closure at 18 mo of age
Age at last follow up21 yr6 yr9 yr6 yr13 yr3 yr
Final clinical statusAlive, deafness due to aminoglycosides. in remission, off therapy for 18 yrAlive, in remission; on AzaAlive, persistent disease, on CS, Aza. Developmentally delayed.Alive, persistent disease, on CS, Aza and IFX. Parents refused surgeryAlive, in remission; off therapy for 2 yrAlive, in remission; no therapy
Table 2 Comparison of disease characteristics, management and final outcome of infantile-onset inflammatory bowel disease and children with onset of disease after 12 mo of age
Onset before 1 year, n (%)Onset after 1 year, n (%)P value
Median age at diagnosis (yr)0.448.34
Duration of follow-up (yr), median (range)6.1 (1.4-19.6)8.3 (1.0-16.6)
Crohn’s disease322
Ulcerative colitis219
Initial presentation, n (%)
Bloody diarrhea6 (100)23 (55)0.039
Perianal disease3 (50)8 (19)0.11
Extraintestinal involvement
Autoimmune liver disease0 (0)8 (19)0.31
Biologics-infliximab3 (50)15 (36)0.40
Surgery3 (50)12 (29)0.27
Disease status at final review
Inactive disease or in clinical remission3 (50)27 (66)0.40
Discontinuation of immunosuppression
Yes3 (50)5 (12)0.053
No3 (50)36 (88)
Table 3 Clinical characteristics, management and outcome of infantile-onset inflammatory bowel disease in selected series
Ref.Patients in all age group), n (%)Nature of patients, n (%)Age of patients at onset of diseaseDuration of follow-up (yr), median (range)Medical therapiesSurgery, n (%)Disease status: remission of survivors at final review, n (%)Deaths
1Ruemmele et al[8]10 (2.5)CD = 4 (40)First 12 mo2.5 (2.5-8)Bowel rest, PN, CS, Aza, CsA3 (30);10 (100);None
UC = 2 (20)2 colectomy, 1 ileostomyoff therapy, 2 (20);
IC = 4 (40)ongoing therapy, 8 (80)
2Cannioto et al[9]16 (8.6)CD = 6 (37.5)First 2 yr6 (4-22)Aggressive multi-drug therapy, Aza, IFX, thalidomide, CsA3 (19);11 (100);5 (mortality rate 31%)1
UC = 8 (50)2 colectomy, 1 ileostomyoff therapy, 4 (25);
Indeterminate = 2 (12.5)ongoing therapy, 6 (38),
after BMT, 1 (6)
3Begue et al[15]13 (-)All had pancolitis, 6 had small bowel involvement2First 12 mo--4 (31)All required immuno-suppressive therapy. Final disease status not describedNot described
4Present study, Malaysia, 20166 (13)CD = 4 (67)First 12 mo5 (1.5-20)Bowel rest, steroids, Aza, CsA, INF3 (33);4 (67);None
UC = 2 (33)1 colectomy, 2 ileostomiesoff therapy, 3 (50);
ongoing therapy, 1 (17);
not in remission, 2 (33)