Among the 294 deaths, 133 were because of cancer. Consequently, individuals with childhood-onset inflammatory bowel disease had a more than sixfold greater risk of dying from cancer than the general population (HR, 6.6; 95% CI, 5.3-8.2). The risk of death from malignancy was higher among individuals with ulcerative colitis (HR, 9.7) than among those with Crohn’s disease (HR, 3.1). Deaths from conditions of the digestive system were next most common, and these included deaths from liver failure.
In all, 27 individuals with childhood-onset inflammatory bowel disease died before their 18th birthday, for a fivefold increase in the adjusted hazard of death, compared with the general population of children and adolescents (HR, 4.9; 95% CI, 3.0-7.7). There was no significant trend in hazard of death according to calendar period, either among children and adolescents, or young adults (followed through age 25 years), the researchers said.
Additionally, childhood-onset inflammatory bowel disease was associated with a 2.2-year shorter life expectancy in patients followed through age 65 years, they reported. Thus, a diagnosis of childhood-onset inflammatory bowel disease merits careful follow-up, especially if patients have ulcerative colitis and primary sclerosing cholangitis, which was the strongest correlate of fatal intestinal cancer in this study.
Funders included the Swedish Medical Society, the Swedish Cancer Society, the Swedish Research Council, the Swedish Foundation for Strategic Research, Magtarmfonden, the Jane and Dan Olsson Foundation, the Mjölkdroppen Foundation, and the Karolinska Institutet Foundation. Dr. Olén disclosed investigator-initiated grants from Janssen and Pfizer. Other investigators also disclosed ties to Janssen, Pfizer, AstraZeneca, Ferring, Celgene, and Takeda.
SOURCE: Olén O et al. Gastroenterology. 2018 Oct 17. doi: 10.1053/j.gastro.2018.10.028.