Clinical Phenotypes and Outcomes in Monogenic Versus Non-monogenic Very Early Onset Inflammatory Bowel Disease

Lauren V. Collen, David Y. Kim, Michael Field, Ibeawuchi Okoroafor, Gwen Saccocia, Sydney Driscoll Whitcomb, Julia Green, Michelle Dao Dong, Jared Barends, Bridget Carey, Madison E. Weatherly, Shira Rockowitz, Piotr Sliz, Enju Liu, Alal Eran, Leslie Grushkin-Lerner, Athos Bousvaros, Aleixo M. Muise, Christoph Klein, Vanessa MitsialisJodie Ouahed, Scott B. Snapper

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background and Aims: Over 80 monogenic causes of very early onset inflammatory bowel disease [VEOIBD] have been identified. Prior reports of the natural history of VEOIBD have not considered monogenic disease status. The objective of this study is to describe clinical phenotypes and outcomes in a large single-centre cohort of patients with VEOIBD and universal access to whole exome sequencing [WES]. Methods: Patients receiving IBD care at a single centre were prospectively enrolled in a longitudinal data repository starting in 2012. WES was offered with enrollment. Enrolled patients were filtered by age of diagnosis <6 years to comprise a VEOIBD cohort. Monogenic disease was identified by filtering proband variants for rare, loss-of-function, or missense variants in known VEOIBD genes inherited according to standard Mendelian inheritance patterns. Results: This analysis included 216 VEOIBD patients, followed for a median of 5.8 years. Seventeen patients [7.9%] had monogenic disease. Patients with monogenic IBD were younger at diagnosis and were more likely to have Crohn's disease phenotype with higher rates of stricturing and penetrating disease and extraintestinal manifestations. Patients with monogenic disease were also more likely to experience outcomes of intensive care unit [ICU] hospitalisation, gastrostomy tube, total parenteral nutrition use, stunting at 3-year follow-up, haematopoietic stem cell transplant, and death. A total of 41 patients [19.0%] had infantile-onset disease. After controlling for monogenic disease, patients with infantile-onset IBD did not have increased risk for most severity outcomes. Conclusions: Monogenic disease is an important driver of disease severity in VEOIBD. WES is a valuable tool in prognostication and management of VEOIBD.

Original languageEnglish
Pages (from-to)1380-1396
Number of pages17
JournalJournal of Crohn's and Colitis
Issue number9
StatePublished - 1 Sep 2022


  • Very early onset inflammatory bowel disease
  • disease course
  • whole exome sequencing

ASJC Scopus subject areas

  • General Medicine


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