Case 21.3
On further evaluation, patient is noted to have Hemoglobin of 10.0 gm/dl, elevated ESR 24 mm/hr with mildly elevated CRP 3.5 mg/L (normal 2.0 mg/L) and calprotectin 1200 mcg/d. Infectious stool testing negative. Esophagogastroduodenoscopy showed normal esophagus, erythematous mucosa in the antrum, cardia, and fundus of the stomach with exudates in the antrum. The duodenal bulb and second portion of the duodenum appeared normal. Colonoscopy showed aphthae and exudate throughout the entire colon and normal appearing terminal ileum. Pathology revealed chronic active gastritis and chronic active colitis throughout the entire colon including rectum with eosinophilic infiltration. No granulomas. A diagnosis of VEO IBD is made.
Which of the following statements regarding VEO IBD are accurate? (click all that apply)
Very early onset inflammatory bowel disease (VEO-IBD) is defined as IBD that presents in infants and children less than 6 years of age.
Less than 1 % have a monogenic defect (one gene is involved in causing the IBD phenotype)
Children with VEO IBD need careful immunologic evaluation
Can have a severe course with poor response to conventional immunosuppressives
Small bowel is more common than colon involvement