PSC-IBD linked with greater growth impairments among children
Features of inflammatory bowel disease differed between children with primary sclerosing cholangitis and those without it, similar to adult patients, according to study results.
“Despite the mild clinical activity of IBD in patients with PSC, lack of symptoms does not always indicate lack of mucosal inflammation,” Amanda Ricciuto, MD, FRCPC, PhD, from the division of gastroenterology, hepatology and nutrition at the Hospital for Sick Children in Toronto, Canada, and colleagues wrote. “Children with PSC-IBD have greater growth impairments compared with children with ulcerative colitis or IBD-unclassified.”
During a retrospective study from 2000 to 2018, researchers identified 74 children diagnosed with PSC- IBD. They matched these patients to two children with ulcerative colitis or IBS-unclassified based on sex, date of birth and IBD type. Investigators compared IBD distribution, clinical activity and patient growth between the groups. Mixed effects analyses or Cox proportional hazards regression adjusted for time-dependent medication exposure was used to assess data extracted from each hospital contact.
Results showed more patients with PSC-IBD, compared with control participants, had backwash ileitis, pancolitis and rectal sparing, and more severe right-sided disease (P < .05). Investigators said patients with PSC-IBD vs. controls were more likely to be treated with 5-ASA (OR = 3.04; 95% CI, 1.44–6.41) and have IBD in clinical remission (OR, 2.94; 95% CI, 1.78–4.87). Patients with PSC-IBD vs. control patients had a lower risk for colectomy or treatment with a biologic agent (HR = 0.24; 95% CI, 0.12–0.52); however, IBD severity based on symptoms was underestimated based on one endoscopic activity in patients with PSC-IBD. Patients with PSC, among those with IBD in clinical remission had less a chance of having endoscopic remission (OR = 0.44; 95% CI, 0.2–0.96). PSC-IBD patients vs. control patients were shorter and had lower weight over time.
“The finding of subclinical inflammation highlights the need for disease monitoring strategies that extend beyond symptom assessment,” Ricciuto and colleagues wrote. “In addition, recognition of the unique IBD phenotype may facilitate earlier recognition of PSC, at a stage when the mechanisms that underlie progressive biliary inflammation and fibrosis are best elucidated and much needed therapeutic interventions developed.”