Extraintestinal Manifestations Of Pediatric Inflammatory Bowel Disease: A Tunisian Single-Center Experience

Introduction The incidence of pediatric inflammatory bowel disease (IBD) increased during last years. However, extra intestinal manifestations (EIM) in children with IBD are poorly characterized. The aim of this study was to describe clinical features of extraintestinal manifestations of IBDs in the Tunisian pediatric population. Methods We conducted a retrospective study from 2012 to 2017 of children admitted to the pediatric gastroenterology department of BECHIR HAMZA Children’s Hospital for Crohn’s disease (CD) or ulcerative colitis (UC). Results We collected 14 patients, six boys and eight girls, five cases with UC and nine cases with CD. The mean age at diagnosis was 10±3.3 years [18 month-14 years]. EIMs were reported in ten of 14 patients. EIMs included aphthous stomatitis (n=3), osteoporosis/osteopenia (n=4), peripheral joint infammation (n=5), primary sclerosing cholangitis (n=1), ankylosing spondylitis (n=1), cerebral venous thrombosis (n=1) and cerebral vasculitis (n=1). We observed three children with skin involvement : one with erythema nodosum, the other with ulcerative skin eruption and a case of vitiligo. EIMs were more frequent in CD than UC (7/9 vs 3/5, p = 0.041). EIM appeared before IBD diagnosis in 11/18 cases. Three patients were treated with anti-TNF agents, six with azathioprine and only one with methotrexate. Conclusion The prevalence of EIMs in children with IBD in our study was high mainly in patients with CD. EIM may appear before IBD diagnosis. Knowledge of these fndings may led to an increased awareness of underlying IBD, thereby decreasing diagnostic delay.