Background and aims Complications of inflammatory bowel disease (IBD) may involve gastro-intestinal system and several other organs. Extraintestinal manifestations (EIMs) are reported in about one third of adults with IBD and they may be related or not to disease activity, or adverse effects related to therapy (ADR, Adverse Drug Reactions). In paediatric patients EIMs are yet poorly understood, with few published data. Here we describe local complications and EIMs in our paediatric series of IBD patients.

Methods Five paediatric patients (age 10–18) with complicated IBD were enrolled. Diagnosis of IBD was obtained by integrating clinical data, laboratory tests, imaging studies (Magnetic Resonance Enterography) and endoscopy. All underwent protocol therapy with azathioprine and mesalazine.

Results 80% of patients (4/5) had a Crohn’s disease, 20% (1/5) an indeterminate colitis. 4 patients (80%) were females. Local complications reported were 2 cases of intestinal occlusion which required long hospitalisation, antibiotic therapy and total parenteral nutrition, and 1 case of bowel fistulization and formation of abscess treated with combined antibiotic and biological therapy. The most frequent EIMs were ADR: 2 cases of recurrent hypertransaminasemia due to mesalazine, 2 asymptomatic pancreatitis by azathioprine, 1 hypercortisolism with osteopenia, hypertrichosis and round face. All the reported ADR resolved spontaneously stopping the drug administration. The remaining observed EIMs were 1 case of Sweet’s syndrome with spontaneous resolution and 1 case of sideropenic anaemia.

Conclusions In our patients local complications of IBD were severe and required hospitalisation with aggressive therapy; ADR were mostly due to reversible effects of treatment. This emphasises the need for more targeted therapies in children.