P078 Pediatric onset IBD has a more severe disease course compared to adulthood onset: A population-based study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".