Pediatric infl ammatory bowel disease: experience in a tertiary pediatric center

The aim of the study was to assess the clinical features and diagnostic work-up in patients newly diagnosed with infl ammatory bowel disease in our center. We prospectively collected data on all children (N=158) diagnosed with infl ammatory bowel disease at our center from January 2004 to September 2012. During the 8.7-year period, 78 (49.4%) children were diagnosed with Crohn’s disease, 73 (46.2%) with ulcerative colitis and 7 (4.4%) with indeterminate colitis. Retrospective analysis yielded the following for Crohn’s disease: (a) the PCDAI at diagnosis was 29.4 (range 15-60); (b) the most common presenting symptoms were abdominal pain, diarrhea and weight loss; (c) 28 (35.9%) patients had stunted growth already at presentation; and (d) the predominant location was ileocolonic (n=48; 61.5%), perianal disease was found in 37 (47.4%) and upper gastrointestinal tract was aff ected in 26 (33.3%) patients; and for ulcerative colitis: (a) a signifi cant rise in the incidence was observed in the last two years; (b) the PUCAI at diagnosis was 26.2 (range 10- >65); (c) the most common presenting symptoms were diarrhea and blood in stool; and (d) most patients had extensive disease with either pancolitis (n=40; 54.7%) or extensive colitis (n=10; 13.4%). The role of small bowel follow through was dubious in our hands as it confi rmed endoscopically proven terminal ileum involvement in only 31.3% of Crohn’s disease patients. In conclusion, no diff erence was found in the incidence rate of Crohn’s disease and ulcerative colitis; moreover, towards the end of the study, more children were diagnosed with ulcerative colitis. Our patients presented with extensive form of the disease. In diagnostic work-up, magnetic resonance imaging enterography should be done whenever possible.

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