Presentation and Clinical Outcomes of Inflammatory Bowel Disease in Children and Adolescents at a Tertiary Care Center in Lebanon

Background: Pediatric-onset inflammatory bowel disease (IBD) is a chronic relapsing condition leading to substantial morbidity and variable disease course. Early recognition of factors associated with suboptimal outcomes may improve risk stratification and therapeutic strategy. This retrospective cohort study intended to analyze the association between initial presentation characteristics and early disease course in pediatric-onset IBD. Methods: Included were pediatric patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) followed at the American University of Beirut Medical Center between 2013 and 2023. Demographic, anthropometric, laboratory, endoscopic, radiologic, and clinical data were gathered from medical records. Validated pediatric activity indices were used to assess severity, and early outcomes covered mainly the first remission. Results: Eighty-eight patients were evaluated for baseline characteristics, and eighty-one patients were analyzed for treatment outcomes. Among 88 subjects, 62.5% had CD and 37.5% had UC, with a mean age at diagnosis of 11.29 (±4.60) years. The most encountered presenting symptoms were abdominal pain, diarrhea, and hematochezia, with 44.9% of subjects having malnutrition. Clinical remission after initial treatment was obtained in 60.2% of subjects. A past medical history of autoimmune or inflammatory disease was linked to persistent symptoms, whereas initial use of corticosteroids was associated with early clinical remission. Conclusions: Pediatric IBD in our cohort was marked by extensive disease involvement, high inflammatory burden, nutritional impairment, and frequent flare or treatment escalation. Corticosteroid initiation at diagnosis was associated with early clinical remission in this retrospective cohort. Nevertheless, this association should be interpreted cautiously, as the retrospective design and potential confounding by indication limit any inference regarding causality or treatment superiority. The high rate of subsequent flare underscores the need for early risk stratification and individualized multidisciplinary care to improve long-term outcomes.