Association of extraintestinal manifestations and disease severity in paediatric inflammatory bowel disease: a multicentre cohort study.

Abstract

Objective: Extraintestinal manifestations (EIMs) are common in paediatric inflammatory bowel disease (IBD), often impairing quality of life. Our aim was to assess whether EIMs at diagnosis are associated with disease severity in paediatric IBD.

Methods: We conducted a post hoc analysis from the Hungarian Pediatric IBD Registry (2010-2020), including children with Crohn's disease (CD) or ulcerative colitis (UC). Outcomes (relapse, steroid dependency, biological therapy (BT), surgery) were compared between patients with EIMs at diagnosis and those without, using Kaplan-Meier and Cox regression analyses.

Results: Among 1590 patients, EIMs were more frequent in CD than in UC (25% vs 14%, p<0.0001). In CD, EIMs were linked to earlier steroid dependency (p=0.0047) and BT initiation (p=0.00049). Patients without EIMs had a higher risk of intestinal resection (HR 3.2; 95% CI 1.572 to 6.472; p=0.001). In UC, EIMs were not associated with relapse (p=0.600), steroid dependency (p=0.890) or need for BT (p=0.081). Colectomy occurred earlier in the patients with EIMs (p=0.032).

Conclusion: In patients with CD, EIM at diagnosis more often required BT, but underwent fewer surgeries. In patients with UC, EIMs at diagnosis appeared to be associated with an increased risk of BT and colectomy.