Understanding Long-Term Severity of Pediatric Onset IBD in the Presence of Peripheral Blood Eosinophilia

Researchers from the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at UPMC Children’s Hospital of Pittsburgh, along with colleagues in the adult Division of Gastroenterology, Hepatology and Nutrition, published new findings in 2020 on the severity of disease in IBD patients diagnosed as children in long-term follow-up as adults.

Division fellow Krishnapriay M. Prathapan, MD, was the first author of the study. Internationally respected IBD researcher Sandra C. Kim, MD, director of the Inflammatory Bowel Disease Center at UPMC Children’s, was a senior author on the study and a mentor of Dr. Prathapan.

Published in the journal Inflammatory Bowel Diseases in 2020, the new study examined data from a prospective database of IBD patients at UPMC — in two cohorts: patients with adult-onset IBD and adult patients who experienced pediatric-onset IBD. The aim of the research was to determine if an indication of peripheral blood eosinophilia can be used as a biomarker to identify patients at high-risk for a severe disease course that persists into adulthood.

While peripheral eosinophilia can have a variety of causes, such as primary malignancies or infections and allergic reactions, elevated eosinophil production also can be seen in cases of IBD. Chronically elevated eosinophil levels can induce organ damage as a result of inflammatory pathways.

Adult IBD patients identified as having peripheral blood eosinophilia have been shown to have a more severe or aggressive IBD trajectory over the long-term. Pediatric patients diagnosed in childhood with peripheral blood eosinophilia are known to exhibit a more robust clinical manifestation of IBD.

In this study, the researchers examined a dataset consisting of 2,800 adult IBD patients, who were then segmented into pediatric-onset and adult-onset cohorts. Patients records span from 2009 to 2018. 23.4% of the 2,800 patients were identified as having a pediatric-onset disease course. In terms of patients who exhibited peripheral blood eosinophilia at the time of IBD diagnoses, a greater percentage of pediatric-onset patients (34%) exhibited the clinical characteristic versus 26.4% of the adult-onset IBD patients. Adult patients with a pediatric-onset case of IBD and diagnosis of peripheral blood eosinophilia showed a clear difference in several key clinical areas, pointing to a more severe disease course that continued from childhood into adulthood. The patients exhibited higher persistent levels of C reactive protein, elevated levels of erythrocyte sedimentation, and they also showed greater levels of health care utilization and associated increased health care costs.

“It appears as if peripheral blood eosinophilia (PBE), when accompanying a diagnosis of IBD in pediatric patients, portends a higher risk for a more severe case of the disease, the severity of which persists as the patient ages into adulthood. Using PBE as a prognosticator for those who may be susceptible to aggressive variants of IBD could allow us to take more aggressive actions earlier in an attempt to mitigate disease severity long-term. Through additional research, we may find the risk to be stratified in various ways, but at a minimum, knowing that PBE appears to be a marker for persistent, greater disease severity will help us better screen our patients for potential worse trajectories as they age,” says Dr. Kim.

Full details and findings from the study can be found at the reference below.

Reference

Prathapan KM, Rivers CR, Anderson A, et al. Peripheral Blood Eosinophilia and Long-Term Severity in Pediatric-Onset Inflammatory Bowel Disease. Inflamm Bowel Dis. 2020; 26(12): 1890-1900.

More About the IBD Center at UPMC Children’s Hospital of Pittsburgh

The Inflammatory Bowel Disease (IBD) Center uses a team approach to provide each patient with the most advanced medical care available and compassionate support for the whole family. The IBD Center provides comprehensive, state-of-the-art clinical care to control the symptoms of IBD and to improve the quality of life for children with the disease. Sandra C. Kim, MD, is the director of the IBD Center at UPMC Children’s.