Extra Intestinal Manifestations in Children with Inflammatory Bowel Disease, A Single Center Report from Iran

Seyed Mohsen Dehghani, Iraj Shahramian, Ali Bazi, Seyedeh Zeinab Fereidouni, Asma Erjaee, Leila Salarian

Abstract


Introduction: Inflammatory bowel disease (IBD) is a disorder of unknown etiology categorized into three groups including Crohn disease (CD), ulcerative colitis [UC], and intermediate colitis (IC). In addition to gastrointestinal (GI) symptoms, childhood IBD frequently present with extra GI manifestations. In present study, we aimed to determine extra GI symptoms in children with IBD in Iran. Methods: Children <18 years old with established IBD diagnosis referred to the Gastroenterology Clinic affiliated with Shiraz University of Medical Sciences during 2007-2017 were included. Results: Eighty-five children were assessed. CD and UC comprised 26 (30.6%) and 47 (55.3%) of the patients. The mean age was 14.09±2.5 years old with 50% of them were boys. The most frequent presenting complaint was rectal bleeding (37.2%). In patients with CD and UC, 30% and 29% of the patients represented at least one extra GI symptom. The most common extra GI manifestations were growth retardation (11.5%) and arthralgia (7.8%) in children with CD and UC respectively. Conclusions: Extra GI symptoms are relatively common in children with IBD. Caution should be taken to avoid confusion with other disorders and to timely manage these manifestations.

Keywords


Inflammatory Bowel Disease, Crohn Disease, Ulcerative Colitis, Extra Intestinal Manifestation

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References


Li X, Shen J, Ran Z. Crosstalk between the gut and the liver via susceptibility loci: Novel advances in inflammatory bowel disease and autoimmune liver disease. Clin Immunol. 2017;175:115-23.

Uzzan M, Galicier L, Gornet JM, Oksenhendler E, Fieschi C, Allez M, et al. Autoimmune cytopenias associated with inflammatory bowel diseases: Insights from a multicenter retrospective cohort. Dig Liver Dis. 2017;49(4):397-404.

Sartor RB. Microbial influences in inflammatory bowel disease: role in pathogenesis and clinical implications. Kirsner's inflammatory bowel diseases. 2004:138-62.

Yangyang RY, Rodriguez JR, editors. Clinical presentation of Crohn’s, ulcerative colitis, and indeterminate colitis: Symptoms, extraintestinal manifestations, and disease phenotypes. Semin Pediatr Surg; 2017: Elsevier.

Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. The American journal of gastroenterology. 2001;96(4):1116-22.

Nanji AA, Denardi FG. Primary adult lactose intolerance protects against development of inflammatory bowel disease. Med Hypotheses. 1986;19(1):1-6.

Karlinger K, Györke T, Makö E, Mester Á, Tarján Z. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol. 2000;35(3):154-67.

Dehghani SM, Erjaee A, Abolfathi L, Honar N, Imanieh MH, Haghighat M. Epidemiology of pediatric inflammatory bowel diseases in Southern Iran. Middle East journal of digestive diseases. 2012;4(2):102.

Mamula P, Markowitz JE, Baldassano RN. Inflammatory bowel disease in early childhood and adolescence: special considerations. Gastroenterology Clinics. 2003;32(3):967-95.

Jose FA, Heyman MB. Extraintestinal manifestations of inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2008;46(2):124.

Grossman B, DeBenedetti C. Extraintestinal manifestations of chronic inflammatory bowel disease in children. The Proceedings of the Institute of Medicine of Chicago. 1970;28(3):119-.

Ficarra G, Cicchi P, Amorosi A, Piluso S. Oral Crohn's disease and pyostomatitis vegetans: an unusual association. Oral Surg Oral Med Oral Pathol. 1993;75(2):220-4.

Wee A, Ludwig J. Pericholangitis in chronic ulcerative colitis: primary sclerosing cholangitis of the small bile ducts? Ann Intern Med. 1985;102(5):581-7.

Brink MA, Slors JFM, Keulemans YC, Mok KS, De Waart DR, Carey MC, et al. Enterohepatic cycling of bilirubin: a putative mechanism for pigment gallstone formation in ileal Crohn's disease. Gastroenterology. 1999;116(6):1420-7.

Bernstein CN. Extraintestinal manifestations of inflammatory bowel disease. Current gastroenterology reports. 2001;3(6):477-83.

Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine. 1976;55(5):401-12.

Monsen U, Sorstad J, Hellers G, Johansson C. Extracolonic diagnoses in ulcerative colitis: an epidemiological study. Am J Gastroenterol. 1990;85(6).

Kumar V, Abbas AK, Aster JC. Robbins basic pathology e-book: Elsevier Health Sciences; 2017.

Hernandez-Tejero M, Granja Navacerrada A, Bernal Checa P, Pique Becerra R, Algaba Garcia A, Guerra Marina I, et al. Prevalence, risk factors and response to treatment of extra-intestinal manifestations in patients with inflammatory bowel disease. Rev Esp Enferm Dig. 2017;109(9):627-33.

Barclay ML, Stamp LK. Editorial: vedolizumab as a treatment and cause of extra-intestinal manifestations of inflammatory bowel disease. Aliment Pharmacol Ther. 2018;47(4):535-6.

Perez-Alamino R, Maldonado-Ficco H, Maldonado-Cocco JA. Rheumatic manifestations in inflammatory bowel diseases: a link between GI and rheumatology. Clin Rheumatol. 2016;35(2):291-6.

Aghazadeh R, Zali MR, Bahari A, Amin K, Ghahghaie F, Firouzi F. Inflammatory bowel disease in Iran: a review of 457 cases. J Gastroenterol Hepatol. 2005;20(11):1691-5.

Karmiris K, Avgerinos A, Tavernaraki A, Zeglinas C, Karatzas P, Koukouratos T, et al. Prevalence and Characteristics of Extra-intestinal Manifestations in a Large Cohort of Greek Patients with Inflammatory Bowel Disease. Journal of Crohn's & colitis. 2016;10(4):429-36.

Card TR, Langan SM, Chu TP. Extra-Gastrointestinal Manifestations of Inflammatory Bowel Disease May Be Less Common Than Previously Reported. Dig Dis Sci. 2016;61(9):2619-26.

Tomasello G, Scaglione M, Mazzola M, Gerges Geaga A, Jurjus A, Gagliardo C, et al. Crohns disease and extra intestinal granulomatous lesions. J Biol Regul Homeost Agents. 2018;32(1):7-11.

Fallahi GH, Moazzami K, Tabatabaeiyan M, Zamani MM, Asgar-Shirazi M, Najafi M, et al. Clinical characteristics of Iranian pediatric patients with inflammatory bowel disease. Acta Gastroenterol Belg. 2009;72(2):230-4.

Taleban S, Li D, Targan SR, Ippoliti A, Brant SR, Cho JH, et al. Ocular Manifestations in Inflammatory Bowel Disease Are Associated with Other Extra-intestinal Manifestations, Gender, and Genes Implicated in Other Immune-related Traits. Journal of Crohn's & colitis. 2016;10(1):43-9.

Engel MA, Neurath MF. New pathophysiological insights and modern treatment of IBD. J Gastroenterol. 2010;45(6):571-83.

Yamamoto-Furusho JK, Sarmiento-Aguilar A. Joint involvement in Mexican patients with ulcerative colitis: a hospital-based retrospective study. Clin Rheumatol. 2018;37(3):677-82.

Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. Journal of Crohn's & colitis. 2017;11(6):649-70.

Muthas D, Reznichenko A, Balendran CA, Bottcher G, Clausen IG, Karrman Mardh C, et al. Neutrophils in ulcerative colitis: a review of selected biomarkers and their potential therapeutic implications. Scand J Gastroenterol. 2017;52(2):125-35.

Rossel JB, Biedermann L, Frei P, Zeitz J, Spalinger M, Battegay E, et al. Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study. PLoS One. 2017;11(11):1326-34.

Nambu R, Hagiwara S, Kubota M, Kagimoto S. Difference between early onset and late-onset pediatric ulcerative colitis. Pediatr Int. 2016;58(9):862-6.

Herzog D, Fournier N, Buehr P, Rueger V, Koller R, Heyland K, et al. Age at disease onset of inflammatory bowel disease is associated with later extraintestinal manifestations and complications. Eur J Gastroenterol Hepatol. 2018;30(6):598-607.

Gasparetto M, Guariso G, Pozza LV, Ross A, Heuschkel R, Zilbauer M. Clinical course and outcomes of diagnosing Inflammatory Bowel Disease in children 10 years and under: retrospective cohort study from two tertiary centres in the United Kingdom and in Italy. BMC Gastroenterol. 2016;16:35.

Skrzat A, Olczak-Kowalczyk D, Turska-Szybka A. Crohn's disease should be considered in children with inflammatory oral lesions. Acta Paediatr. 2017;106(2):199-203.

Hindryckx P, Novak G, Costanzo A, Danese S. Disease-related and drug-induced skin manifestations in inflammatory bowel disease. Expert review of gastroenterology & hepatology. 2017;11(3):203-14.

Fagagnini S, Heinrich H. Risk factors for gallstones and kidney stones in a cohort of patients with inflammatory bowel diseases. 2017;12(10):e0185193.

Severs M, van Erp SJ, van der Valk ME, Mangen MJ, Fidder HH, van der Have M, et al. Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease. Journal of Crohn's & colitis. 2016;10(4):455-61.




DOI: https://doi.org/10.7575/aiac.abcmed.v.9n.2p.5

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