{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T14:53:16Z","timestamp":1769266396559,"version":"3.49.0"},"reference-count":61,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pediatric inflammatory bowel disease (pIBD), including Crohn\u2019s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), exhibits unique clinical features compared to adult-onset disease. This study aimed to describe phenotypic characteristics of pIBD in the north-west region of Romania over a 21-year period and to compare our findings with those of other studies worldwide. Methods: We conducted a retrospective study of children under 18 years of age, from the north-west region of Romania, diagnosed with pIBD between 2000 and 2020 at the Emergency Clinical Hospital for Children, Cluj-Napoca. Disease phenotype at diagnosis was established according to the Paris classification. Data were collected from the hospital records and analyzed using descriptive statistics and univariate analysis of categorical variables. A p-value &lt; 0.05 was considered statistically significant. Results: Ninety-four patients were included (CD: 51.0%; UC: 43.6%; IBD-U: 5.4%), with a median age at diagnosis of 14 years (11\u201315.7). Very early-onset IBD accounted for 5.3% of cases. The likelihood of being diagnosed with CD after 10 years of age was significantly higher compared to UC (OR = 4.75, 95% CI: 1.10\u201329.07, p = 0.03). UC most frequently presented as pancolitis (51.2%), while CD most often involved the ileocolonic region (56.3%). Inflammatory behavior was the most common CD phenotype (69%). Upper gastrointestinal involvement was documented in 18.7% of CD cases, with detection rates increasing after 2014. Perianal disease and growth impairment were significantly associated with complicated CD behavior (p = 0.03, and p = 0.007 respectively). Our findings are broadly consistent with other published reports. Conclusions: This study provides the first detailed phenotypic characterization of pIBD in this region. Our findings reflect trends observed in other populations and underscore the importance of standardized diagnostic evaluation.<\/jats:p>","DOI":"10.3390\/jcm14134597","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T13:06:17Z","timestamp":1751288777000},"page":"4597","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Two Decades of Pediatric Inflammatory Bowel Disease in North-Western Romania: Phenotypic Characteristics and Diagnostic Trends"],"prefix":"10.3390","volume":"14","author":[{"given":"Georgia Valentina","family":"Tartamus (Tita)","sequence":"first","affiliation":[{"name":"3rd Medical Discipline, Department of Internal Medicine, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0906-1232","authenticated-orcid":false,"given":"Daniela Elena","family":"Serban","sequence":"additional","affiliation":[{"name":"Department of Mother and Child, 2nd Clinic of Pediatrics, Emergency Clinical Hospital for Children, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel Vasile","family":"Tantau","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Gastroenterology, \u201cProf. Dr. Octavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/MPG.0000000000000239","article-title":"ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents","volume":"58","author":"Levine","year":"2014","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.dld.2021.12.018","article-title":"Epidemiological trends of pediatric IBD in Italy: A 10-year analysis of the Italian society of pediatric gastroenterology, hepatology and nutrition registry","volume":"54","author":"Alvisi","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1002\/ibd.21349","article-title":"Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends","volume":"17","author":"Benchimol","year":"2011","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1053\/j.gastro.2021.12.282","article-title":"Twenty-first Century Trends in the Global Epidemiology of Pediatric-Onset Inflammatory Bowel Disease: Systematic Review","volume":"162","author":"Kuenzig","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.3748\/wjg.v24.i25.2741","article-title":"Current global trends in the incidence of pediatric-onset inflammatory bowel disease","volume":"24","author":"Sykora","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1097\/00054725-200810001-00005","article-title":"Inflammatory bowel disease: The difference between children and adults","volume":"14","author":"Kelsen","year":"2008","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1053\/j.gastro.2008.06.081","article-title":"Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease","volume":"135","author":"Russell","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1093\/jcag\/gwy056","article-title":"The Impact of Inflammatory Bowel Disease in Canada 2018: Children and Adolescents with IBD","volume":"2","author":"Carroll","year":"2019","journal-title":"J. Can. Assoc. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"van Dalen, M., van Gaalen, M.A.C., Favejee, M.M., den Hollander-Ardon, M.S., Dulfer, K., de Ridder, L., and Escher, J.C. (2025). Implementing routine medical and mental health screening in children and adolescents with inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr., in press.","DOI":"10.1002\/jpn3.70039"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1002\/ibd.21493","article-title":"Pediatric modification of the Montreal classification for inflammatory bowel disease: The Paris classification","volume":"17","author":"Levine","year":"2011","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.cgh.2017.05.047","article-title":"Ethnicity Influences Phenotype and Outcomes in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Studies","volume":"16","author":"Shi","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1136\/gutjnl-2012-303954","article-title":"Advances in inflammatory bowel disease pathogenesis: Linking host genetics and the microbiome","volume":"62","author":"Knights","year":"2013","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1097\/MIB.0000000000000483","article-title":"Pediatric IBD-unclassified Is Less Common than Previously Reported; Results of an 8-Year Audit of the EUROKIDS Registry","volume":"21","author":"Winter","year":"2015","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1016\/j.cgh.2022.10.026","article-title":"Incidence, Management, and Outcomes of Very Early Onset Inflammatory Bowel Diseases and Infantile-Onset Disease: An Epi-IIRN Study","volume":"21","author":"Atia","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tartamus, G.V., Serban, D.E., Fogas, C.R., and Tantau, M.V. (2025). Pediatric Inflammatory Bowel Disease in Romania: The First Epidemiological Study of the North-West Region (2000\u20132020). Children, 12.","DOI":"10.3390\/children12040403"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1053\/j.gastro.2007.05.029","article-title":"Development, validation, and evaluation of a pediatric ulcerative colitis activity index: A prospective multicenter study","volume":"133","author":"Turner","year":"2007","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.3748\/wjg.v28.i17.1830","article-title":"Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: Insights from an Asian-Pacific multi-centre registry network","volume":"28","author":"Huang","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/MPG.0b013e31829f7d8c","article-title":"Incidence, Paris classification, and follow-up in a nationwide incident cohort of pediatric patients with inflammatory bowel disease","volume":"57","author":"Muller","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/ajg.2017.228","article-title":"Dramatic Increase in Incidence of Ulcerative Colitis and Crohn\u2019s Disease (1988\u20132011): A Population-Based Study of French Adolescents","volume":"113","author":"Ghione","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1097\/MPG.0000000000002660","article-title":"Regional Incidence of Inflammatory Bowel Disease in a Czech Pediatric Population: 16 Years of Experience (2002\u20132017)","volume":"70","author":"Jabandziev","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"412","DOI":"10.5217\/ir.2019.00130","article-title":"Phenotypic characteristics of pediatric inflammatory bowel disease in Japan: Results from a multicenter registry","volume":"18","author":"Arai","year":"2020","journal-title":"Intest. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1093\/ecco-jcc\/jjw146","article-title":"Clinical Characteristics and Long-Term Outcomes of Paediatric Crohn\u2019s Disease: A Single-Centre Experience","volume":"11","author":"Kim","year":"2017","journal-title":"J. Crohns Colitis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1002\/ibd.23008","article-title":"Disease phenotype at diagnosis in pediatric Crohn\u2019s disease: 5-year analyses of the EUROKIDS Registry","volume":"19","author":"Paerregaard","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/MPG.0000000000001688","article-title":"Rising Incidence of Paediatric Inflammatory Bowel Disease in Canterbury, New Zealand, 1996\u20132015","volume":"66","author":"Lopez","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/ibd.22980","article-title":"Increasing incidence of pediatric inflammatory bowel disease in Spain (1996\u20132009): The SPIRIT Registry","volume":"19","author":"Rodriguez","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.crohns.2013.08.009","article-title":"Incidence and clinical course of Crohn\u2019s disease during the first year-results from the IBD Cohort of the Uppsala Region (ICURE) of Sweden 2005\u20132009","volume":"8","author":"Sjoberg","year":"2014","journal-title":"J. Crohns Colitis"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1038\/ajg.2017.97","article-title":"Trends in Epidemiology of Pediatric Inflammatory Bowel Disease in Canada: Distributed Network Analysis of Multiple Population-Based Provincial Health Administrative Databases","volume":"112","author":"Benchimol","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_28","first-page":"519","article-title":"Incidence and Phenotype at Diagnosis of Very-early-onset Compared with Later-onset Paediatric Inflammatory Bowel Disease: A Population-based Study [1988\u20132011]","volume":"11","author":"Bequet","year":"2017","journal-title":"J. Crohns Colitis"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lee, W.S., Chew, K.S., Huang, J.G., Tanpowpong, P., Mercado, K.S.C., Reodica, A., Logarajah, V., Hathagoda, K.L.W., Rajindrajith, S., and Wong, Y.K. (2025). Disease phenotypic and outcome of very-early onset inflammatory bowel disease in Asian children: An understudied population. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1487253"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.iac.2018.08.008","article-title":"Early-Onset Inflammatory Bowel Disease","volume":"39","author":"Kelsen","year":"2019","journal-title":"Immunol. Allergy Clin. North. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1053\/j.gastro.2014.06.023","article-title":"Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease","volume":"147","author":"Benchimol","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","article-title":"Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: A systematic review of population-based studies","volume":"390","author":"Ng","year":"2017","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/MPG.0000000000002035","article-title":"Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn\u2019s and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition","volume":"67","author":"Turner","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/MPG.0000000000002036","article-title":"Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis-An Evidence-based Consensus Guideline From the European Crohn\u2019s and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition","volume":"67","author":"Turner","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1093\/ecco-jcc\/jjad111","article-title":"Clinical Features and Natural History of Paediatric Patients with Ulcerative Proctitis: A Multicentre Study from the Paediatric IBD Porto Group of ESPGHAN","volume":"17","author":"Tal","year":"2023","journal-title":"J. Crohns Colitis"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1053\/j.gastro.2020.07.066","article-title":"Predicting Outcomes in Pediatric Ulcerative Colitis for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease-Ahead Program","volume":"160","author":"Aardoom","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1053\/j.gastro.2020.07.065","article-title":"Predicting Outcomes in Pediatric Crohn\u2019s Disease for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease-Ahead Program","volume":"160","author":"Ricciuto","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MPG.0000000000003335","article-title":"Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease","volume":"74","author":"Berger","year":"2022","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1093\/ecco-jcc\/jjae091","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Medical Treatment","volume":"18","author":"Gordon","year":"2024","journal-title":"J. Crohns Colitis"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1093\/ibd\/izac215","article-title":"Induction of Remission With Exclusive Enteral Nutrition in Children With Crohn\u2019s Disease: Determinants of Higher Adherence and Response","volume":"29","author":"Cuomo","year":"2023","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_41","first-page":"171","article-title":"The Medical Management of Paediatric Crohn\u2019s Disease: An ECCO-ESPGHAN Guideline Update","volume":"15","author":"Aloi","year":"2020","journal-title":"J. Crohns Colitis"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/MPG.0b013e3181da1db8","article-title":"Inflammatory bowel disease developing in paediatric and adult age","volume":"51","author":"Guariso","year":"2010","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/ajg.2012.389","article-title":"Relationship between proximal Crohn\u2019s disease location and disease behavior and surgery: A cross-sectional study of the IBD Genetics Consortium","volume":"108","author":"Lazarev","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1093\/ecco-jcc\/jjy121","article-title":"Upper Gastrointestinal Tract Involvement in Crohn\u2019s Disease: Frequency, Risk Factors, and Disease Course","volume":"12","author":"Greuter","year":"2018","journal-title":"J. Crohns Colitis"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1016\/j.dld.2021.07.037","article-title":"Systematic review with meta-analysis: The prevalence, risk factors and outcomes of upper gastrointestinal tract Crohn\u2019s disease","volume":"53","author":"Chin","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/ecco-jcc\/jjy113","article-title":"ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications","volume":"13","author":"Maaser","year":"2019","journal-title":"J. Crohns Colitis"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"19032","DOI":"10.1038\/s41598-020-75938-1","article-title":"Upper gastrointestinal tract involvement is more prevalent in Korean patients with pediatric Crohn\u2019s disease than in European patients","volume":"10","author":"Kim","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_48","unstructured":"Group, W.B. (2025, June 09). GDP per capita (current US$)\u2014Romania. Available online: https:\/\/data.worldbank.org\/indicator\/NY.GDP.PCAP.CD?end=2023&locations=RO&start=1987&view=chart."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.crohns.2011.06.013","article-title":"Upper gastrointestinal involvement in paediatric onset Crohn\u2019s disease: Prevalence and clinical implications","volume":"6","author":"Crocco","year":"2012","journal-title":"J. Crohns Colitis"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/00054725-200207000-00002","article-title":"Long-term evolution of disease behavior of Crohn\u2019s disease","volume":"8","author":"Cosnes","year":"2002","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3345\/cep.2021.00661","article-title":"Upper gastrointestinal tract involvement of Crohn disease: Clinical implications in children and adolescents","volume":"65","author":"Kim","year":"2022","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1136\/gutjnl-2018-318081","article-title":"Assessment of Crohn\u2019s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: A systematic review","volume":"68","author":"Bettenworth","year":"2019","journal-title":"Gut"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1038\/ajg.2014.424","article-title":"Characterization of inflammation and fibrosis in Crohn\u2019s disease lesions by magnetic resonance imaging","volume":"110","author":"Rimola","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1016\/j.cgh.2019.04.025","article-title":"Noninvasive Multimodal Methods to Differentiate Inflamed vs Fibrotic Strictures in Patients With Crohn\u2019s Disease","volume":"17","author":"Allocca","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1097\/MPG.0000000000003752","article-title":"Approach to Endoscopic Balloon Dilatation in Pediatric Stricturing Crohn Disease: A Position Paper of the Endoscopy Special Interest Group of ESPGHAN","volume":"76","author":"Ledder","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1097\/MPG.0000000000001177","article-title":"Growth Pattern in Paediatric Crohn Disease Is Related to Inflammatory Status","volume":"63","author":"Ley","year":"2016","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1002\/ibd.20115","article-title":"Growth retardation in pediatric Crohn\u2019s disease: Pathogenesis and interventions","volume":"13","author":"Shamir","year":"2007","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1053\/j.sempedsurg.2017.10.010","article-title":"Long-term outcomes of pediatric inflammatory bowel disease","volume":"26","author":"Nasiri","year":"2017","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.crohns.2009.07.001","article-title":"Frequency of indeterminate colitis in children and adults with IBD\u2014A metaanalysis","volume":"3","author":"Prenzel","year":"2009","journal-title":"J. Crohns Colitis"},{"key":"ref_60","unstructured":"Nimbal (2025, June 09). Professor Nimbal Comic Book. Available online: https:\/\/www.nimbal.org\/professor-nimbal-thank-you."},{"key":"ref_61","unstructured":"APSPIIR (2025, June 11). Profesor Nimbal. Available online: https:\/\/aspiir.ro\/bii-pediatrie-materiale-informative\/bolile-inflamatorii-intestinale-pe-intelesul-copiilor-intr-o-carte-de-benzi-desenate\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4597\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:01:04Z","timestamp":1760032864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4597"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,28]]},"references-count":61,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134597"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134597","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,28]]}}}