Epidemiological aspects of indeterminate colitis

Most children with indeterminate colitis are evaluated because of recurrent abdominal pain and diarrhea, with a smaller number noting hema-tochezia.12 In young children (less than 5 years of age), failure to thrive is more prominent than seen in ulcerative colitis.13 Hassan et al noted no difference in gender, age at diagnosis or types of symptom at presentation among the 38 newly diagnosed children with ulcerative colitis, indeterminate colitis and Crohn's disease.14

The prevalence of indeterminate colitis in reported series of patients with IBD varies among centers from 5 to 23%2-6 (Table 24.1). In our pediatric population of 428 children actively followed with IBD, 49 (11.4%) were diagnosed with indeterminate colitis4 (Table 24.2). In 42.9% of those with indeterminate colitis, the histology 'favored ulcerative colitis' but these patients also had features of

Table 24.1 Prevalence of indeterminate colitis (IC)

Total no. of

Age

Indeterminate

Peak age (years)

IBD patients

group

colitis patients

IC UC

Gupta et al4

420

pediatric

51 (11.9%)

10

Heikenen et al5

91

pediatric

9 (10%)

7.8 9.7

Hildebrand et al3

132

pediatric

36 (27%)

— —

Stewenius et al15

10-19 20-29

Meucci et al10

1113

adult

50 (4.6%)

— —

Shivananda et al2

2201

adult

116 (5.3%)

— —

IBD, inflammatory bowel disease; UC, u

Icerative colitis

Table 24.2 Indeterminate colitis: histological features in 49 pediatric patients at the University of Chicago (from reference 4)

'Favor ulcerative colitis': 43% - except for the presence of: Focal colitis

Colonic granulomas adjacent to ruptured crypts Gastroduodenal inflammation (Helicobacter pylori negative) Anal fissure

'Favor Crohn's disease': 18% - except for findings of:

Absence of granulomas

No small-bowel X-ray features of Crohn's disease No distinguishing features: 39%

Crohn's disease including areas of focal colitis, focal gastric or duodenal inflammation, anal fissures or isolated granulomas adjacent to ruptured crypts. Features 'favoring Crohn's disease' were present in 20.4% of children with indeterminate colitis, none of whom had granulomas, radiological evidence of small-bowel Crohn's disease or perianal findings. Endoscopic and histological findings of IBD without distinguishing features of ulcerative colitis or Crohn's disease were present in 36.7% of our patients with indeterminate colitis.

Heikenen et al noted a similar prevalence of indeterminate colitis (10%) in a pediatric population of IBD.5 These authors noted that children with indeterminate colitis were diagnosed at a younger age (7.8 years) than those with either ulcerative colitis (9.7 years) or Crohn's disease (11.4 years). Similarly, in Sweden, the peak age range at diagnosis was younger (10-19 years) for patients with indeterminate colitis in comparison with ulcerative colitis (20-29 years).15 A particularly high prevalence of indeterminate colitis (23%) has been reported from one pediatric center in Sweden.3

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