Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study

Dana Duricova; Ariane Leroyer; Guillaume Savoye; Hélène Sarter; Benjamin Pariente; Djamila Aoucheta; Laura Armengol-Debeir; Delphine Ley; Dominique Turck; Laurent Peyrin-Biroulet; Corinne Gower-Rousseau; Mathurin Fumery; EPIMAD Group

doi:10.1093/ecco-jcc/jjx092

Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study

J Crohns Colitis. 2017 Oct 27;11(11):1326-1334. doi: 10.1093/ecco-jcc/jjx092.

Authors

Dana Duricova¹, Ariane Leroyer¹, Guillaume Savoye², Hélène Sarter^{1

3}, Benjamin Pariente⁴, Djamila Aoucheta⁵, Laura Armengol-Debeir², Delphine Ley^{3

6}, Dominique Turck^{3

6}, Laurent Peyrin-Biroulet⁷, Corinne Gower-Rousseau^{1

3}, Mathurin Fumery^{3

8}; EPIMAD Group

Collaborators

EPIMAD Group:
J M Andre, M Antonietti, A Aouakli, A Armand, I Aroichane, F Assi, J P Aubet, E Auxenfants, F Ayafi-Ramelot, D Bankovski, B Barbry, N Bardoux, P Baron, A Baudet, B Bazin, A Bebahani, J P Becqwort, V Benet, H Benali, C Benguigui, E Ben Soussan, A Bental, I Berkelmans, J Bernet, K Bernou, C Bernou-Dron, P Bertot, N Bertiaux-Vandaële, V Bertrand, E Billoud, N Biron, B Bismuth, M Bleuet, F Blondel, V Blondin, P Bohon, E Boniface, P Bonnière, E Bonvarlet, P Bonvarlet, A Boruchowicz, R Bostvironnois, M Boualit, B Bouche, C Boudaillez, C Bourgeaux, M Bourgeois, A Bourguet, A Bourienne, J Branche, G Bray, F Brazier, P Breban, H Brihier, V Brung-Lefebvre, P Bulois, P Burgiere, J Butel, J Y Canva, V Canva-Delcambre, J P Capron, F Cardot, P Carpentier, E Cartier, J F Cassar, M Cassagnou, J F Castex, P Catala, S Cattan, S Catteau, B Caujolle, G Cayron, C Chandelier, M Chantre, J Charles, T Charneau, M Chavance-Thelu, D Chirita, A Choteau, J F Claerbout, P Y Clergue, H Coevoet, G Cohen, R Collet, J F Colombel, S Coopman, J Corvisart, A Cortot, F Couttenier, J F Crinquette, V Crombe, I Dadamessi, V Dapvril, T Davion, S Dautreme, J Debas, N Degrave, F Dehont, C Delatre, R Delcenserie, O Delette, T Delgrange, L Delhoustal, J S Delmotte, S Demmane, G Deregnaucourt, P Descombes, J P Desechalliers, P Desmet, P Desreumaux, G Desseaux, P Desurmont, A Devienne, E Devouge, M Devred, A Devroux, A Dewailly, S Dharancy, A Di Fiore, D Djeddi, R Djedir, M L Dreher-Duwat, R Dubois, C Dubuque, P Ducatillon, J Duclay, B Ducrocq, F Ducrot, P Ducrotté, A Dufilho, C Duhamel, D Dujardin, C Dumant-Forest, J L Dupas, F Dupont, Y Duranton, A Duriez, K El Achkar, M El Farisi, C Elie, M C Elie-Legrand, A Elkhaki, M Eoche, D Evrard, J P Evrard, A Fatome, B Filoche, L Finet, M Flahaut, C Flamme, D Foissey, P Fournier, M C Foutrein-Comes, P Foutrein, D Fremond, T Frere, M Fumery, P Gallet, C Gamblin, S Ganga-Zandzou, R Gerard, G Geslin, Y Gheyssens, N Ghossini, S Ghrib, T Gilbert, B Gillet, D Godard, P Godard, J M Godchaux, R Godchaux, G Goegebeur, O Goria, F Gottrand, P Gower, B Grandmaison, M Groux, C Guedon, J F Guillard, L Guillem, F Guillemot, D Guimber, B Haddouche, S Hakim, D Hanon, V Hautefeuille, P Heckestweiller, G Hecquet, J P Hedde, H Hellal, P E Henneresse, B Heyman, M Heraud, S Herve, P Hochain, L Houssin-Bailly, P Houcke, B Huguenin, S Iobagiu, A Ivanovic, I Iwanicki-Caron, E Janicki, M Jarry, J Jeu, J P Joly, C Jonas, F Katherin, A Kerleveo, A Khachfe, A Kiriakos, J Kiriakos, O Klein, M Kohut, R Kornhauser, D Koutsomanis, J E Laberenne, G Laffineur, M Lagarde, P Lannoy, J Lapchin, M Lapprand, D Laude, R Leblanc, P Lecieux, N Leclerc, C Le Couteulx, J Ledent, J Lefebvre, P Lefiliatre, C Legrand, A Le Grix, P Lelong, B Leluyer, C Lenaerts, L Lepileur, A Leplat, E Lepoutre-Dujardin, H Leroi, M Y Leroy, J P Lesage, X Lesage, J Lesage, I Lescanne-Darchis, J Lescut, D Lescut, B Leurent, P Levy, M Lhermie, A Lion, B Lisambert, F Loire, S Louf, A Louvet, M Luciani, D Lucidarme, J Lugand, O Macaigne, D Maetz, D Maillard, H Mancheron, O Manolache, A B Marks-Brunel, R Marti, F Martin, G Martin, E Marzloff, P Mathurin, J Mauillon, V Maunoury, J L Maupas, B Mesnard, P Metayer, L Methari, B Meurisse, F Meurisse, L Michaud, X Mirmaran, P Modaine, A Monthe, L Morel, P E Mortier, E Moulin, O Mouterde, J Mudry, M Nachury, E N'Guyen Khac, B Notteghem, V Ollevier, A Ostyn, A Ouraghi, D Ouvry, B Paillot, N Panien-Claudot, C Paoletti, A Papazian, B Parent, B Pariente, J C Paris, P Patrier, L Paupart, B Pauwels, M Pauwels, R Petit, M Piat, S Piotte, C Plane, B Plouvier, E Pollet, P Pommelet, D Pop, C Pordes, G Pouchain, P Prades, A Prevost, J C Prevost, B Quesnel, A M Queuniet, J F Quinton, A Rabache, P Rabelle, G Raclot, S Ratajczyk, D Rault, V Razemon, N Reix, M Revillon, C Richez, P Robinson, J Rodriguez, J Roger, J M Roux, A Rudelli, A Saber, G Savoye, P Schlosseberg, M Segrestin, D Seguy, M Serin, A Seryer, F Sevenet, N Shekh, J Silvie, V Simon, C Spyckerelle, N Talbodec, A Techy, J L Thelu, A Thevenin, H Thiebault, J Thomas, J M Thorel, G Tielman, M Tode, J Toisin, J Tonnel, J Y Touchais, Y Touze, J L Tranvouez, C Triplet, D Turck, S Uhlen, E Vaillant, C Valmage, D Vanco, H Vandamme, E Vanderbecq, E Vander Eecken, P Vandermolen, P Vandevenne, L Vandeville, A Vandewalle, C Vandewalle, P Vaneslander, J P Vanhoove, A Vanrenterghem, P Varlet, I Vasies, G Verbiese, G Vernier-Massouille, P Vermelle, C Verne, P Vezilier-Cocq, B Vigneron, M Vincendet, J Viot, Y M Voiment, A Wacrenier, L Waeghemaecker, J Y Wallez, M Wantiez, F Wartel, J Weber, J L Willocquet, N Wizla, E Wolschies, A Zalar, B Zaouri, A Zellweger, C Ziade

Affiliations

¹ Public Health, Epidemiology and Economic Health, Registre EPIMAD, Lille University and Hospital, Lille, France.
² Gastroenterology Unit, EPIMAD Registry, Rouen University Hospital, Rouen, France.
³ Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, Lille, France.
⁴ Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, Lille, France.
⁵ Associated Medical Director, Immunology, MSD France, Courbevoie cedex, France.
⁶ Division of Gastroenterology, Hepatology and Nutrition, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France.
⁷ Gastroenterology Unit, Inserm U954, Nancy University and Hospital, Nancy, France.
⁸ Gastroenterology Unit, EPIMAD Registry, Amiens University Hospital, Amiens, France.

PMID: 28981648
DOI: 10.1093/ecco-jcc/jjx092

Abstract

Background and aims: Data on extra-intestinal manifestations [EIM] and their impact on the disease course of ulcerative colitis [UC] in population-based cohorts are scarce, particularly in paediatric- and elderly-onset UC patients. The aims of this population-based study were to assess: 1] the occurrence of EIM in paediatric- and elderly-onset UC; 2] the factors associated with EIM; and 3] their impact on long-term disease outcome.

Methods: Paediatric-onset [< 17 years at diagnosis] and elderly-onset UC patients [> 60 years at diagnosis] from a French prospective population-based registry [EPIMAD] were included. Data on EIM and other clinical factors at diagnosis and at maximal follow-up were collected.

Results: In all, 158 paediatric- and 470 elderly-onset patients were included [median age at diagnosis 14.5 and 68.8 years, median follow-up 11.2 and 6.2 years, respectively]. EIM occurred in 8.9% of childhood- and 3% of elderly-onset patients at diagnosis and in 16.7% and 2.2% of individuals during follow-up [p < 0.01], respectively. The most frequent EIM was joint involvement [15.8% of paediatric onset and 2.6% of elderly-onset]. Presence of EIM at diagnosis was associated with more severe disease course [need for immunosuppressants or biologic therapy or colectomy] in both paediatric- and elderly-onset UC (hazard ratio [HR] = 2.0, 95% confidence interval [CI]: 1.0-4.2; and HR = 2.8, 0.9-7.9, respectively). Extensive colitis was another independent risk factor in both age groups.

Conclusions: Elderly-onset UC patients had lower risk of EIM either at diagnosis or during follow-up than paediatric-onset individuals. EIM at diagnosis predicted more severe disease outcome, including need for immunosuppressive or biologic therapy or surgery, in both paediatric- and elderly-onset UC.

Keywords: Extra-intestinal manifestation; elderly; paediatric.

MeSH terms

Adolescent
Age Factors
Age of Onset
Aged
Colitis, Ulcerative / diagnosis
Colitis, Ulcerative / pathology*
Female
Humans
Male
Risk Factors
Treatment Outcome