P064  Clinical Aspects of Pediatric Inflammatory Bowel Disease – A Multicentric Study From Brazil

P064  Clinical Aspects of Pediatric Inflammatory Bowel Disease – A Multicentric Study From Brazil

 

Bordin Jaqueline1, Coronel Juliana2, dos Santos Beatriz3, Dias Caroline1, Nunes Daltro4, Pinto Raquel5, Ceza Marília2, Ramos Ana Regina5, Goldani Helena2, Ferreira Cristina Helena1, Scheeffer Vanessa1
1 Hospital da Criança Santo Antônio, Porto Alegre, Brazil, 2 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, 3 Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, 4 Hospital de Clinicas de Porto Alegre, R. Ramiro Barcelos, Porto Alegre, Brazil, 5 Hospital Nossa Senhora da Coinceição, Porto Alegre, Brazil

BACKGROUND: Pediatric inflammatory bowel disease (PIBD) is a diagnostic which comprises three subtypes: Crohn’s Disease (CD), Ulcerative Colitis (UC) and IBD-unclassified (IBD-U) (Levine, 2014). Paris classification aims to unify definitions of its phenotypes (Levine, 2011). There is still a lack of studies in the Brazilian pediatric population.

METHODS: Records from three reference centers from a city at the south of Brazil were researched and 96 patients with PIBD were identified. We aimed to describe clinical aspects in this population with PIBD. Patients were seen between 2014 and 2019 and data regarding disease aspects were collected. Statistical data analysis was performed using SPSS22.0 (IBM,Armonk,NY,USA). For all analyses, P < 0.05 was considered significant.

RESULTS: Ninety-six patients (51% females) with PIBD were included, 58.3% of these had CD, 34.4% had UC and 7.3% had IBD-U.  Median time from initial symptoms to diagnostic was 11 months in CD and 12 months in UC. Mean age at diagnosis was 9.7 years (±4.5) for CD and 10.9 years (±4.2) for UC. 58.2% of the patients with CD were classified as A1b of Paris. Clinical score severity (PCDAI or PUCAI) was not associated with time until diagnosis, gender, or age of onset. Change from initial diagnosis was observed in 12.5% of patients with CD and 6.1% with UC.  The most frequent symptoms presented at diagnosis were diarrhea (77.8%), abdominal pain (64,.4%) and rectal bleeding (56.9%). Rectal bleeding was significantly more frequently observed in UC (90.6%) than CD (56.9%) – p=0.003.  Anemia was statically associated with bloody diarrhea (p=0.039). Although weight loss was frequently observed (table 1), most patients did not present with growth retardation (23.6% in CD and 12.1% in UC).  Regarding disease localization, 16.4% of patients with CD presented with Paris L1 subtype (distal 1/3 ileum ± limited cecal disease), 41.8% Paris L2 (colonic), 38.2% Paris L3 (38,2%) and 3.6% Paris L4b (upper disease distal to ligament of Treitz and proximal to distal 1/3 ileum).  Regarding disease behavior, 71.4% of patients with CD presented Paris B1 (non-stricturing, non-penetrating), 7.1% Paris B2 (stricturing), 19.6% Paris B3 (penetrating) and 1.8% Paris B4. As expected, colon and rectal disease was more frequently observed in UC than CD (p < 0.001). Median number of surgery procedures was 1 for both CD and UC. The hospital admissions median was 1 for CD and 2 for UC.

CONCLUSION(S): Median age of diagnosis was similar both in CD and UC. CD was more frequently observed in our population. Time from initial symptoms until diagnosis remains high (median of 1 year) and was not related to disease severity in this analysis. The most frequent symptoms were diarrhea, abdominal pain and bloody diarrhea. The most frequent extra-intestinal manifestations observed were weight loss and anemia. Anemia was associated with occurrence of bloody diarrhea, indicating loss, not consumption, in most cases. Twenty-four percent of patients with CD presented either with stricturing or penetrating disease, highlighting severity in the pediatric population. About 20% of the population with CD presented either with isolated ileal disease or upper GI tract disease, highlighting the importance of ileal intubation and small bowel assessment.