P322 High body mass index and anaemia at diagnosis are predictors of extra-intestinal manifestations in children with inflammatory bowel disease

Abstract

Extra-intestinal manifestations (EIM) are common in inflammatory bowel disease (IBD). Although well-investigated, the current ability to predict occurrence of EIM, especially among children, is poor. The aim of our study was to define predictors for EIM in children with IBD. We included children with IBD from the paediatric gastroenterology unit, “Dana-Dwek” children’s hospital, in the years 2010–2016. We retrospectively compared demographic and disease variables at diagnosis between children with and without EIM. Children were categorised in quartiles according to body mass index (BMI) percentiles at diagnosis. Disease activity was evaluated by the paediatric Crohn’s disease/ulcerative colitis activity indices (PCDAI/PUCAI). One hundred children were evaluated: 62 with Crohn’s disease and 38 with ulcerative colitis. The median age (IQR) at diagnosis was 13.9 (11.9–15.2) years. Ten children (10%) presented with EIM at diagnosis and additional 36 children (36%) exhibited EIM during median (IQR) follow-up of 2.1 (1.2–3.8) years. The most common EIM were aphthous stomatitis (18%), arthralgia (14%), skin manifestations (8%), and arthritis (6%). Variables at diagnosis that were associated with occurrence of EIM during follow-up were BMI in the lower or upper quartile (HR 9.3 and 23.7, respectively, p < 0.001, Figure 1), moderate-to-severe disease activity (HR 4.4, p < 0.001, Figure 2), anaemia (HR 2.3, p < 0.001), abnormal C-reactive protein (HR 1.04, p < 0.001), and extensive involvement in Crohn’s disease (HR 3.4, p = 0.025). In a multivariate analysis, anaemia (HR 2.1, p < 0.001) and BMI in the upper quartile (HR 3.54, p = 0.004) at diagnosis were associated with EIM. Several predictors for EIM in children with IBD were identified. Further studies are needed to elucidate whether children with high risk for EIM should be treated more aggressively from diagnosis.