INDIAN CHILDHOOD CIRRHOSIS (ICC) IN NORTH WEST INDIA: FIRE UNDER THE ASHES!!!
Vikrant Khanna*, Abhinav Sharma**, Harsh Deep Sahni***, Ujjal Poddar****, SK Yachha *****
Department of Gastroenterology (Pediatric gastroenterology) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow *, Department of Gastroenterology (Pediatric gastroenterology) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow **, Department of Gastroenterology (Pediatric gastroenterology) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow ***, Department of Gastroenterology (Pediatric gastroenterology) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow ****, Department of Gastroenterology (Pediatric gastroenterology) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow *****
Introduction: There is not much information about inflammatory bowel disease (IBD) in children from India (none from North India). We therefore analyzed our experience on clinical spectrum of IBD.

Methods: From June 1999 to June 2005, a total of 14 cases of IBD were managed at our center. Ulcerative colitis (UC) and Crohn's disease (CD) were diagnosed on the basis of clinical features, endoscopic appearance and histological findings. Tuberculosis and allergic colitis were ruled out in all cases of IBD.

Results: Of the 14 cases with IBD, UC and CD was diagnosed in 8 (5 boys) and 6 (4 boys) cases respectively. Median (range) age in years at onset and presentation were 11.5 (5-15.5) and 12.5 (8-17) for UC, and 3.58 (0.5-9) and 5.8 (0.7-11) for CD respectively.

At presentation, none of the cases with UC had fever anorexia or pain abdomen and their disease activity was severe in 4, moderate in 3 and mild in 1. Six of 8 had pancolitis on colonoscopy. On treatment, all went into remission with steroid while 3/8 (steroid dependent) cases required azathioprine. All 8 cases continued to be in remission over median (range) follow up of 6 (1.5-42) months.

In CD group, 3 cases each had pain abdomen and fever as prominent symptom while one had anorexia. Diarrhea was of large bowel (type in 3, mixed small + large type in 2 and pure small bowel type in 1. Two cases had perianal disease. Histologically, 3/6 had granuloma (2 on rectal and 1 on antral biopsy). All 6 received steroid + 5ASA while 4/6 were given azathioprine. On median (range) duration of follow up in CD 6 (3-46.5), all were maintaining remission.

Comparing the 2 groups, we find that cases with CD had an earlier onset but more delay in presentation and had prominent constitutional systems.

Conclusion: IBD does present in pediatric age group. CD in North Indian children has an early onset and more cases of CD required azathioprine for maintenance of remission.
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