P078 Pediatric onset IBD has a more severe disease course compared to adulthood onset: A population-based study
Notice bibliographique
Résumé
BACKGROUND: The existing population-based comparative studies between adult onset IBD (aIBD) and pediatric onset IBD (pIBD) consistently report, that pediatric onset of ulcerative colitis (pUC) present with more extensive disease. In this population-based study, we aim to further characterize the differences in the natural history between pIBD and aIBD. METHODS: AIBD patients included (>18 years of age) were diagnosed from January 2003 to December 2004. PIBD patients were diagnosed from January 1998 to December 2008 (<15 years of age). Both cohorts are population-based. All medical records were retrieved manually at time of last follow-up, and clinical data concerning IBD phenotype (Montreal classification 1 ) and treatment were registered. Number of relapses were recorded as defined by Romberg-Camps et al 2 . Differences regarding medical treatment and surgery was calculated using Cox regression analysis. Comparison of risk of relapse (IRR) was calculated using Poisson regression. All other comparisons were calculated using Chi 2 . RESULTS: 446 aIBD (CD/UC 183/263) and 333 pIBD (CD/UC/IBDU 166/145/22) patients were included. Median follow-up time was 7.6 years (aIBD) and 8.9 years (pIBD). In CD, 9% aCD and 24% pCD ( P < 0.0001) patients had involvement of the upper GI tract (L4a or L4b either alone or in combination with L1-L3). At diagnosis, 22% and 12% of aCD and pCD, respectively, had non-inflammatory behavior and at end of follow-up this increased to 37% and 48%, respectively ( P = 0.04). 24% and 66% of aUC and pUC, respectively, had extensive disease (E3) at diagnosis ( P < 0.0001). A total of 14% and 42% of aIBD and pIBD patients, respectively, were treated with anti-TNF-alpha (HR: 3.2 (2.4–4.4), P < 0.0001) during follow-up. The increased risk was independent of IBD diagnosis and disease extent. In UC, 41% and 74% of aUC and pUC, respectively received either azathioprine or 6-mercatopurine (IM) during follow-up (HR 3.8 (2.8–5.2), P < 0.0001). This increased risk in pUC was independent of disease extent. Over the first 7 years after diagnosis pIBD patients had an increased risk of relapse compared to aIBD patients IRR 1.8 (CI 1.4–2.2), P < 0.0001. The increased risk of relapses persisted when adjusting for IBD diagnosis and extension. At end of follow-up bowel resection occurred in 18% and 29% of aIBD and pIBD, respectively, resulting in a hazard ratio of 1.4 (CI 0.97–2.0) and 0.9 (CI 0.5–1.7), P = 0.07 in CD and UC, respectively. CONCLUSION(S): PIBD patients had more extensive disease than aIBD patients, were more often treated with immunomodulators and biologic agents and had an increased risk of relapse. Moreover, pCD patients more often developed non-inflammatory behavior and a trend towards increased risk of surgery was noted. Compared to previous results this population-based cohort study demonstrated a clearly more severe disease course in pIBD than in aIBD. Consequently, pIBD patients must be monitored intensively and the top-down treatment protocol should be investigated for pIBD. As a future consequence of the severe disease course and frequent use of immunosuppressive medicine, attention should be paid towards the possible increased cancer risk in these patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».