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The natural course of inflammatory bowel disease-indeterminate from childhood to adulthood: within a 25 year period

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Author(s): Malaty HM | Mehta S | Abraham B | Garnett EA | Ferry GD

Journal: Clinical and Experimental Gastroenterology
ISSN 1178-7023

Volume: 2013;
Issue: default;
Start page: 115;
Date: 2013;
Original page

ABSTRACT
Hoda M Malaty,1 Seema Mehta,2,3 Bincy Abraham,1 Elizabeth A Garnett,4 George D Ferry2,31Department of Medicine, 2Department of Pediatrics, 3Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA; 4University of California, San Francisco, California, USABackground: Inflammatory bowel disease (IBD)-indeterminate is a subgroup of IBD that has features of both ulcerative colitis (UC) and Crohn’s disease (CD).Aims: To determine the clinical course of IBD-indeterminate in children over a 25 year period.Methods: We performed a retrospective investigation on children diagnosed with IBD. Diagnosis and disease distribution of IBD was based on clinical, radiologic, endoscopic, and histologic examinations.Results: Four hundred and twenty children diagnosed with IBD between 1986 and 2003 were identified from the IBD registry, 78 (22%) of whom were diagnosed with IBD-indeterminate. The mean age at diagnosis was 9.2 ± 4 years and the mean follow-up period was 4.1 ± 2 years. In 2003, 18 of 78 children (23%) were reclassified by the same physician based on the endoscopic and pathologic findings as follows: eight children with CD, five children with UC, and five children with non-IBD (eg, eosinophilic colitis). During 2011, 20 of the 60 patients who had maintained an IBD-indeterminate diagnosis were located and contacted, and detailed telephone interviews were conducted by the corresponding author. Two patients were reclassified as having CD (10%), one patient was reclassified as having eosinophilic colitis (5%), six patients remained with IBD-indeterminate (30%), and eleven patients (55%) reported a complete resolution of their symptoms. The follow-up period ranged from 10–18 years (mean 12.5 ± 3 years). Children who were reclassified as having CD were significantly younger than those who maintained an IBD-indeterminate diagnosis (6.4 ± 4 years versus11.2 ± 3 years, respectively, P = 0.05).Conclusion: Children with IBD-indeterminate remain classified as IBD-indeterminate, or were clinically reclassified as CD or non-IBD, or became asymptomatic as they transitioned into adulthood. The need for IBD-indeterminate classification is of importance, especially when deciding on management and treatment.Keywords: IBD-indeterminate, children, epidemiology, clinical course
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