Abstract:
Objective: To explore the spectrum of presentation, underlying monogenetic defects and outcome in very early onset infl ammatory bowel disease (VEO-IBD). Methods: The prospective, observational study was conducted at the Children's Hospital, Lahore, Pakistan, from January 2017 to December 2018, and comprised children developing features of infl ammatory bowel disease aged <6 years. Data included demography, clinical presentation, diagnostic tools and outcome. Data was analysed using SPSS 21. Results: Of the 60 children with relevant symptoms, 26(43.3%) were diagnosed as having very early onset infl ammatory bowel disease. Of them, 13(50%) had underlying monogenic defect, and 16(61.5%) had ulcerative colitis. There were 22(84.6%) males with median age of 1.5(11) months in monogenic infl ammatory bowel disease versus 24(43) months for non-monogenic infl ammatory bowel disease (p<0.05). In the monogenic group, isolated rectal bleeding was the major presentation 13(100%) versus non-monogenic who presented mainly with failure to thrive 13(100%). Upper and lower endoscopies with histopathology had good diagnostic yield and infl ammatory infi ltrates on the biopsied tissues were the major fi ndings. Mutations detected among the subjects were XIAP, PRKDC, PIK3CD, RAG-1, LRBA, DOCK8, TTC7, MEFV and EPCAM. Mortality was signifi cantly higher in the monogenic group 7(54%) than in the non-monogenic group 2(15%) (p<0.05). Conclusion: Very early onset infl ammatory bowel disease should be suspected when conventional management fails to rectify common disease mimickers. Testing for underlying immunological defect and genetic mutation would be helpful for managing these rare disorders.
Page(s):
2350-2354
DOI:
DOI not available
Published:
Journal: Journal of Pakistan Medical Association, Volume: 71, Issue: 10, Year: 2021
Keywords:
Immunodeficiency
,
VEOIBD
,
Very early onset inflammatory bowel disease
,
Monogenic IBD