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

Abstract

Background: 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; clinical course; epidemiology.

Figure 1

The changing course of diagnosis in 2011 of the 60 children who maintained indeterminate colitis diagnosis in 2003. Abbreviations: CD, Crohn’s disease; IBD, inflammatory bowel disease; IC, indeterminate colitis; UC, ulcerative colitis; Eos, eosinophilic.

Figure 2

Treatments received at maximal follow-up in 78 pediatric patients with indeterminate colitis. Abbreviations: 5-ASA, 5-aminosalicylic acids; Dx, diagnosis; IMM, immunomodulator; IV, intravenous.

Figure 3

Steroid treatment received by 51 pediatric patients with indeterminate colitis who received immunomodulators at maximal follow-up. Abbreviations: Dx, diagnosis; IMM, immunomodulator; IV, intravenous.