Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment

被引：89

作者：

Greuter, Thomas ^{[1
,2
]}

Bertoldo, Fabio ^{[2
]}

Rechner, Roman ^{[2
]}

Straumann, Alex ^{[3
]}

Biedermann, Luc ^{[1
]}

Zeitz, Jonas ^{[1
]}

Misselwitz, Benjamin ^{[1
]}

Scharl, Michael ^{[1
]}

Rogler, Gerhard ^{[1
]}

Safroneeva, Ekaterina ^{[4
]}

Ali, Raja A. R. ^{[5
]}

Braegger, Christian ^{[6
,7
]}

Heyland, Klaas ^{[8
]}

Mueller, Pascal ^{[9
]}

Nydegger, Andreas ^{[10
]}

Petit, Laetitia-Marie ^{[11
]}

Schibli, Susanne ^{[12
]}

Furlano, Raoul I. ^{[13
]}

Spalinger, Johannes ^{[14
]}

Schappi, Michela ^{[15
]}

Zamora, Samuel

Froehlich, Florian ^{[16
,17
]}

Herzog, Denise ^{[18
]}

Schoepfer, Alain M. ^{[17
]}

Vavricka, Stephan R. ^{[1
,2
]}

机构：

[1] Univ Zurich Hosp, Div Gastroenterol & Hepatol, Zurich, Switzerland

[2] Triemli Hosp Zurich, Div Gastroenterol & Hepatol, Birmensdorferstr 497, CH-8063 Zurich, Switzerland

[3] Praxis Romerhof, Olten, Switzerland

[4] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland

[5] Natl Univ Malaysia, Div Gastroenterol, Med Ctr, Kuala Lumpur, Malaysia

[6] Univ Childrens Hosp Zurich, Div Gastroenterol, Zurich, Switzerland

[7] Univ Childrens Hosp Zurich, Nutr & Childrens Res Ctr, Zurich, Switzerland

[8] Kantonsspital Winterthur, Dept Pediat, Winterthur, Switzerland

[9] Kinderspital St Gallen, Div Gastroenterol & Hepatol, St Gallen, Switzerland

[10] CHU Vaudois, Univ Lausanne Hosp, Dept Pediat, Div Pediat Gastroenterol & Hepatol, Lausanne, Switzerland

[11] HCUG, Univ Hosp Geneva, Dept Pediat, Geneva, Switzerland

[12] Univ Childrens Hosp Bern, Div Gastroenterol & Hepatol, Bern, Switzerland

[13] UKBB, Univ Childrens Hosp Basel, Div Gastroenterol & Nutr, Basel, Switzerland

[14] LUKS, Kantonsspital Luzern, Dept Pediat, Luzern, Switzerland

[15] Clin Grangettes, Pediat Unit, Geneva, Switzerland

[16] Univ Hosp Basel, Div Gastroenterol & Hepatol, Basel, Switzerland

[17] CHU Vaudois, Div Gastroenterol & Hepatol, Univ Hosp Lausanne, Lausanne, Switzerland

[18] Hop Cantonal Fribourg, Dept Pediat, Fribourg, Switzerland

来源：

JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION | 2017年 / 65卷 / 02期

基金：

瑞士国家科学基金会;

关键词：

anti-tumor necrosis factor; arthritis; extraintestinal manifestations; inflammatory bowel disease; uveitis; CROHNS-DISEASE; ULCERATIVE-COLITIS; PYODERMA-GANGRENOSUM; DIAGNOSTIC DELAY; RISK-FACTORS; INFLIXIMAB; COHORT; IBD; EFFICACY; CHILDREN;

D O I：

10.1097/MPG.0000000000001455

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background:There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). Methods:Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. Results:A total of 55 patients (16.7%) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P=0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5% vs 10.3%, P=0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4%) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4% vs 35.0%, P=0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%). Conclusions:In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.

引用

页码：200 / 206

页数：7

共 35 条

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