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Ben-Tov A, Achler T, Patalon T, Gazit S, Yanai H, Shulman S, Assa A. The Prevalence and Characteristics of Inflammatory Bowel Disease-related Ocular Involvement in Children. Inflamm Bowel Dis 2024:izae160. [PMID: 39046811 DOI: 10.1093/ibd/izae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Ocular manifestations (OMs) in patients with inflammatory bowel disease (IBD) are uncommon, particularly in children. We aimed to explore the prevalence and characteristics of IBD-associated OM in a large cohort study. METHODS A cross-sectional study was performed using the Maccabi Healthcare Services (MHS) database. The eligible population included all patients diagnosed with IBD as children (<18 years) between January 2005 and July 2023. RESULTS Out of 2567 children with IBD (males 55%, Crohn's disease 64%), 78 (3%) were diagnosed with OM at any time during the disease course. In 54 patients (69%), the ocular disease occurred after IBD diagnosis with a median time of 2.6 (0.47-7) years between the 2 events, whereas in 24 patients (31%), ocular involvement preceded IBD diagnosis with a median time of 2.1 (0.6-5.7) years. The presence of ocular involvement was associated with increased usage of systemic corticosteroids (P < .001) and biologic agents (P = .04). There were 55 patients with ocular involvement during childhood who were ever diagnosed with IBD. In this population, ocular involvement was also associated with increased usage of systemic corticosteroids (P < .001). The prevalence of OM among patients with IBD did not change significantly over time (P = .75), with a prevalence of 2.3% at the end of the study period. CONCLUSIONS The prevalence of ocular involvement in children with IBD is rare and steady; it is also associated with a greater usage of systemic corticosteroids and biologic agents, potentially representing a more severe disease course.
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Affiliation(s)
- Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Achler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Henit Yanai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Shiri Shulman
- Ophthalmology Institute, Assuta Medical Center, Tel Aviv, Israel
- Faculty of health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amit Assa
- The Juliet Keidan IInstitute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
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Rodriguez Duran M, O'Keefe GAD. Ocular extraintestinal manifestations and treatments in patients with inflammatory bowel disease. FRONTIERS IN OPHTHALMOLOGY 2024; 3:1257068. [PMID: 38983096 PMCID: PMC11182217 DOI: 10.3389/fopht.2023.1257068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/06/2023] [Indexed: 07/11/2024]
Abstract
Between 3-47% of patients with inflammatory bowel disease (IBD) have extraintestinal manifestations (EIMs), and between 1.3-86.9% of patients with IBD suffer from ocular EIMs (O-EIMs) making the eye the third most common organ affected. These O-EIMs exist among a spectrum, with a variety of types and amounts of inflammation which can lead to decreased vision, and in some cases, vision loss, without treatment. We performed a literature review concerning O-EIMs in patients who had or were later found to have a diagnosis of IBD in order to identify ocular EIMs that commonly occur with IBD and to assess which patients with IBD may be at higher risk of developing O-EIMs. We were also interested in ascertaining whether O-EIMs were more common in specific populations of people or in specific subtypes of IBD. Lastly, we explored the common treatments of O-EIMs in patients with IBD. Upon review of the literature, we found that the most common O-EIMs are episcleritis and uveitis. Anterior uveitis is more commonly seen, although, inflammation may occur in the posterior segment of the eye as well and may also manifest as retinal vasculitis. While these diagnoses are sometimes known retrospectively, most patients present with nonspecific eye complaints of which decreased vision with or without pain is the most common. Visual symptoms associated with ocular EIMs may be non-specific so physicians should have a low threshold to refer to ophthalmology for visual complaints. It is important to keep in mind that ocular EIMs can cluster with skin and joint EIMs. Screening should be prioritized for female patients with Crohn's disease and concurrent arthritis. Treatments for O-EIMs are outlined and compared in this paper as well.
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Affiliation(s)
- Mariana Rodriguez Duran
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ghazala A Datoo O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
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Mitchel EB, Grossman A. Health Care Maintenance in Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am 2023; 52:609-627. [PMID: 37543404 DOI: 10.1016/j.gtc.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Patients with pediatric inflammatory bowel disease (pIBD) are at an increased risk for complications and comorbidities including infection, nutritional deficiencies, growth delay, bone disease, eye disease, malignancy, and psychologic disorders. Preventative health maintenance and monitoring is an important part to caring for patients with pIBD. Although practice is variable and published study within pIBD is limited, this article summarizes the important field of health-care maintenance in pIBD. A multidisciplinary approach, including the gastroenterologist provider, primary care provider, social worker, psychologist, as well as other subspecialists is necessary.
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Affiliation(s)
- Elana B Mitchel
- Children's Hospital of Philadelphia, Gastroenterology, Hepatology and Nutrition, 3500 Civic Center Boulevard, Floor 6, Philadelphia, PA 19104, USA.
| | - Andrew Grossman
- Children's Hospital of Philadelphia, Gastroenterology, Hepatology and Nutrition, 3500 Civic Center Boulevard, Floor 6, Philadelphia, PA 19104, USA
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Yu K, Davidson S, Binenbaum G. Uveitis in pediatric inflammatory bowel disease. J AAPOS 2023; 27:153-155. [PMID: 37201627 DOI: 10.1016/j.jaapos.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 05/20/2023]
Abstract
There are currently no official uveitis screening guidelines for children with inflammatory bowel disease (IBD). In this retrospective cohort study of children with IBD with at least 1 ophthalmologist examination over 12 years, we investigated the prevalence and characteristics of uveitis in pediatric IBD. Outcomes included prevalence of uveitis, age at onset, and clinical characteristics of uveitis. A total of 315 children with IBD (mean age, 11.7 ± 4.3) had 974 eye examinations. Five children (1.6%; 95% CI, 0.7%-3.7%) had uveitis, with mean age at onset of 14.3 ± 5.6 years. Three of 209 children with Crohn's disease (1.4%; 95% CI, 0.5%-4.1%), 2 of 55 with IBD-unclassified (3.6%; 95% CI, 1.0%-12.3%) and 0 of 51 with ulcerative colitis (95% CI, 0.0%-7.0%) had uveitis. All uveitis was symptomatic. In our study cohort, uveitis was rare and symptomatic in pediatric IBD.
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Affiliation(s)
- Kimberley Yu
- University of Southern California Roski Eye Institute, Los Angeles, California
| | - Stefanie Davidson
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Gil Binenbaum
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Rohani P, Abdollah Gorji F, Eshaghi M, Javadi Parvaneh V, Moradi M, Zojaji R. Ocular Complications of Pediatric Inflammatory Bowel Disease: A Case Series From a Pediatric Tertiary Medical Center. Clin Pediatr (Phila) 2022; 61:347-351. [PMID: 35152727 DOI: 10.1177/00099228221078105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Ocular extraintestinal manifestations (O-EIMs) are one of the most well-known EIMs in patients with inflammatory bowel disease (IBD). This study aimed to identify the frequency of O-EIMs in children with IBD, referred to Mofid Children's Hospital, Tehran, Iran, during 2014 to 2019. Methods. Children with IBD, younger than the age of 18 years, who were referred to an ophthalmologist, were included in this study. Results. Ninety-six patients with IBD were examined. Four patients had ocular manifestation of IBD. Two patients had complications due to treatment of IBD. The mean age of the patients was 11.25 ± 4.17 years (range: 5.5-17 years). The O-EIMs included 3 (50.0%) cases of anterior uveitis, 1 (16.7%) case of episcleritis, and 2 (33.3%) cases of posterior subcapsular cataract. Conclusion. O-EIMs are important in children with IBD. Therefore, it is recommended that annual screening for ocular complications be performed in all children with IBD.
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Affiliation(s)
- Pejman Rohani
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdollah Gorji
- Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Mofid Children's Hospital, Tehran, Iran
| | | | | | - Maliheh Moradi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Zojaji
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ottaviano G, Salvatore S, Salvatoni A, Martelossi S, Ventura A, Naviglio S. Ocular Manifestations of Paediatric Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2018. [PMID: 29518184 DOI: 10.1093/ecco-jcc/jjy029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ocular extraintestinal manifestations [O-EIMs] are known complications of Crohn's disease [CD], ulcerative colitis [UC], and inflammatory bowel disease unclassified [IBD-U]. However, data on their prevalence in children are scarce and there are no clear recommendations on what follow-up should be offered. We aimed to review available data on O-EIMs in children. METHODS In January 2018, we performed a systematic review of published English literature using PubMed and EMBASE databases and disease-specific queries. RESULTS Fifteen studies [7467 patients] reported data on O-EIMs prevalence in children. Overall prevalence of O-EIMs was 0.62-1.82%. Uveitis was the most common O-EIM. Meta-analysis showed that children with CD are at increased risk of O-EIMs as compared with children with UC and IBD-U (odds ratio [OR] 2.70, 95% confidence interval [CI] 1.51-4.83). Five studies [357 patients] reported data on ophthalmological screening in asymptomatic children: mild asymptomatic uveitis was identified in a variable proportion of patients [1.06-23.1%], more frequently in male patients with CD and colonic involvement. No evidence of ocular complications from untreated uveitis was detected. A total of 23 case reports [24 patients] were identified. CONCLUSIONS Data on O-EIMs in children are scarce. Prevalence of O-EIMs is lower than in adults but may be underestimated because of the possibility of asymptomatic uveitis; however, the long-term significance of this condition is unknown. Children with CD may be at increased risk of O-EIMs. No recommendations on routine ophthalmological examination can be made, but a low threshold for ophthalmological referral should be maintained. Larger studies in paediatric IBD populations are needed.
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Affiliation(s)
- Giorgio Ottaviano
- Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy
| | - Alessandro Salvatoni
- Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy
| | - Stefano Martelossi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandro Ventura
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Samuele Naviglio
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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