A study of infants who developed inflammatory bowel disease (IBD) found that they recovered at a rate similar to patients who became ill later in childhood.
IBD developing during a child’s first year is rare — seen in less than 1% of cases. The patients sometimes have other genetic conditions that trigger gut inflammation, such as Wiskott-Aldrich syndrome or hyper-IgM syndrome.
Research has shown that mutations in the immune cytokine interleukin 10 (IL-10) gene or its receptor are linked to severe gut inflammation in infants. But most infants with IBD have normal IL-10 signaling, suggesting that other factors are at play.
For the study, “Variable outcome in infantile-onset inflammatory bowel disease in an Asian cohort,” which was published in the World Journal of Gastroenterology, researchers at University Malaya Medical Center in Malaysia and the University of Hong Kong analyzed the medical records of all childhood IBD patients treated at the medical center between 1996 and 2014.
Forty-eight children underwent extensive exams to exclude other causes of gut inflammation. Physicians diagnosed them as having Crohn’s disease, ulcerative colitis (UC) or IBD-unclassified (IBD-U). None of the infants had mutations in the IL-10 or the IL-10 receptor genes.
Six of the children (13 percent) were diagnosed when they were 1 year old or younger. Two had ulcerative colitis, three had Crohn’s disease, and one had IBD-U. None had a family history of IBD or other autoimmune conditions. One, who had a cytomegalovirus infection at birth, was diagnosed with developmental regression at 6 years old.
Except for all having bloody diarrhea as the first sign of disease, characteristics among them were varied:
- Three were breastfed.
- Five received immunosuppressive treatment.
- One needed a special diet.
- Three needed surgery: one underwent total colectomy (colon removal), one had a colostomy, and the third had an ileostomy. The latter two are procedures in which the intestine is cut short and brought to an opening in the abdomen.
The children were followed for a median of 5.5 years, and all survived during that time. By a final review, three had achieved complete remission. Two patients’ Crohn’s disease was inactive, and they were not using immunosuppressants. The last patient went into remission once his colon was removed.
Infants with IBD were more likely than older children to have diarrhea as the first sign of disease, the researchers found. More of the infants stopped immunosuppressive treatment — 50% compared to 12% in older children — but the difference did not reach statistical significance.
“With the exception that children with (infant-onset IBD [IO-IBD]) were more likely to have bloody diarrhea at presentation, there were no significant differences between the IO-IBD and children with the onset of disease after one-year of age in terms of developing autoimmune liver disease, the need for biologics, risk for subsequent surgery, achieving remission at final review, or achieving remission without on-going immunosuppression,” the researchers wrote.