Surgical management of very early onset inflammatory bowel disease

Infographic · Jan 2026 · 2 min read

In brief

This retrospective study of 121 VEO-IBD patients found 22% required surgical intervention, most commonly ostomy creation. Black race, diagnosis before age one, severe disease, growth failure, and perianal involvement were significantly associated with need for surgery, while genetic findings and disease location were not predictive.

22% of VEO-IBD patients required surgery; ostomy creation (69%) was more common than bowel resection (35%).
Black race, diagnosis before age 1, severe disease, growth failure, and perianal disease predict need for surgical intervention.
Genetic findings and disease location did not significantly correlate with surgical need in this VEO-IBD cohort.
Post-operative height velocity and medication requirements showed no significant change after resection or stoma creation.
VEO-IBD predominantly affects colon (63%) with Crohn's phenotype (61%); half of patients transferred from other facilities.

Written by the GCMD Library team from the infographic.

The infographic uses a teal and yellow color scheme with illustrated graphics including an inflamed intestine diagram, a surgeon performing a procedure, and surgical team members. Content is organized in distinct sections with large text blocks highlighting key statistics and findings from a 2008-2024 retrospective study.

Sarah J. Ullrich ∙ Annie Le-Nguyen ∙ Monica Holder ∙ Randi Wittenberg ∙ Allison Caja ∙ Aaron P. Garrison ∙ Beth A. Rymeski ∙ Nelson G. Rosen ∙ Jason S. Frischer

Purpose

The incidence of inflammatory bowel disease in children under six years of age, known as very early-onset inflammatory bowel disease (VEO-IBD) has been increasing. VEO-IBD has distinct clinical phenotypes, treatment response and outcomes, however the role of surgical intervention remains poorly understood. This study examines surgical management in this population.

Methods

We conducted a retrospective review of patients diagnosed with VEO-IBD at a single institution between January 2008 and May 2024. Data on demographics, clinical characteristics, and measures of disease severity were collected and analyzed using descriptive statistics.

Results

A total of 121 patients met criteria for inclusion. The majority of patients were diagnosed with a Crohn's disease phenotype (n = 74, 61.2 %). Disease was most frequently isolated to the colon (n = 76, 62.8 %) or ileocolic (n = 38, 31.4 %). Approximately half of the patients (n = 60, 49.6 %) had previously received treatment at another facility. Surgical intervention was required in 26 patients (21.5 %). Of those who had surgery, 69.2 % had an ostomy created, 34.6 % had a bowel resection, 26.9 % had an anorectal exam under anesthesia. Factors significantly associated with operative intervention included Black race (P = 0.011), diagnosis before one year of age (P = 0.022), height velocity ≤ 2SD (P = 0.005), perianal disease (0.005) and disease severity (P = 0.019). Notably, family history (P = 0.226), positive genetic findings (P = 0.459), disease classification (P = 0.991), and disease location were not significantly linked with the need for surgical intervention. Among children who had a bowel resection or stoma creation, there was no statistically significant difference in post-operative height velocity or medication usage.

Conclusion

This study represents the largest single-center review of surgical interventions in VEO-IBD patients, with a 22 % intervention rate. Black race, age at diagnosis, disease severity, decreased height velocity and presence of perianal disease significantly influence surgical need. Given the heterogeneity of VEO-IBD, further research is necessary to elucidate the role of surgery, as well as surgical outcomes in managing this complex condition.

The text in the image