Mathurin Fumery1, Benjamin Pariente2, Helene Sarter3, Guillaume Savoye4, Claire Spyckerelle5, Djamal Djeddi6, Olivier Mouterde7, Guillaume Bouguen8, Delphine Ley9, Anais Peneau2, Jean-Louis Dupas1, Dominique Turck9, Corinne Gower-Rousseau10. 1. Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France. 2. Gastroenterology Unit, Huriez Hospital, Université Lille Nord de France, Lille, France. 3. Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Université Lille Nord de France, Lille, France; Inserm, Lille University, LIRIC UMR 995, Team 5, France. 4. Gastroenterology Unit, Rouen University Hospital, Rouen, France. 5. Department of Pediatrics, St Vincent de Paul Hospital and Lille Catholic University, Lille, France. 6. Department of Pediatrics, Amiens University Hospital, Amiens, France. 7. Department of Pediatrics, Rouen University Hospital, Rouen, France. 8. Department of Pediatrics, Rouen University Hospital, Rouen, France; Gastroenterology Unit, Rennes University Hospital, Rennes, France. 9. Department of Pediatrics, Jeanne de Flandre Hospital, Université Lille Nord de France, Lille, France. 10. Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Université Lille Nord de France, Lille, France; Inserm, Lille University, LIRIC UMR 995, Team 5, France. Electronic address: corinne.gower@chru-lille.fr.
Abstract
BACKGROUND: Pediatric-onset Crohn's disease (CD) may represent a more severe form of disease. The aim of this study was to describe long-term outcome and identify associated risk factors of complicated behavior in a large population-based pediatric-onset CD cohort. PATIENTS AND METHODS: Cases included all patients recorded in the EPIMAD registry diagnosed with definite or probable CD between January 1988 and December 2004, under the age of 17 years at the time of diagnosis, with at least two years of follow-up. RESULTS: Five hundred and thirty-five patients were included. Median follow-up was 11.1 years [IQR, 7.3-15.0]. At the end of follow-up, 8% (n = 44) of patients had pure ileal disease (L1), 8% (n = 44) had pure colonic disease (L2), and 83% (n = 439) had ileocolonic disease (L3). L4 disease and perianal disease were observed in 42% (n = 227) and 16% (n = 85) of patients, respectively. At the end of follow-up, 58% (n = 308) of patients presented complicated disease behavior (B2, 39% and B3, 19%), and 42% (n = 163) of patients with inflammatory behavior at diagnosis had evolved to complicated behavior. During follow-up, 86% of patients (n = 466) received at least one course of corticosteroids, 67% (n = 357) of patients had been exposed to immunosuppressants and 35% (n = 187) of patients received at least one anti-TNF agent. Forty-three percent (n = 230) of patients underwent at least one intestinal resection. The overall mortality rate was 0.93% and the SMR was 1.6 [0.5-3.8] (p = 0.20). Five cancers were reported with a crude cancer incidence rate of 1.1% and an SIR of 3.3 [1.2-7.0] (p = 0.01). In a multivariate Cox model, ileal (HR, 1.87 [1.09-3.21], p = 0.022) or ileocolonic (HR, 1.54 [1.01-2.34], p = 0.042) and perianal lesions at diagnosis (HR, 1.81 [1.13- 2.89], p = 0.013) were significantly associated with complicated behavior. CONCLUSION: About 80% of patients with pediatric-onset CD presented extensive ileocolonic disease during follow-up. The majority of patients evolved to complicated behavior. Surgery, cancer and mortality were observed in 43%, 0.9% and 0.9% of patients, respectively.
BACKGROUND: Pediatric-onset Crohn's disease (CD) may represent a more severe form of disease. The aim of this study was to describe long-term outcome and identify associated risk factors of complicated behavior in a large population-based pediatric-onset CD cohort. PATIENTS AND METHODS: Cases included all patients recorded in the EPIMAD registry diagnosed with definite or probable CD between January 1988 and December 2004, under the age of 17 years at the time of diagnosis, with at least two years of follow-up. RESULTS: Five hundred and thirty-five patients were included. Median follow-up was 11.1 years [IQR, 7.3-15.0]. At the end of follow-up, 8% (n = 44) of patients had pure ileal disease (L1), 8% (n = 44) had pure colonic disease (L2), and 83% (n = 439) had ileocolonic disease (L3). L4 disease and perianal disease were observed in 42% (n = 227) and 16% (n = 85) of patients, respectively. At the end of follow-up, 58% (n = 308) of patients presented complicated disease behavior (B2, 39% and B3, 19%), and 42% (n = 163) of patients with inflammatory behavior at diagnosis had evolved to complicated behavior. During follow-up, 86% of patients (n = 466) received at least one course of corticosteroids, 67% (n = 357) of patients had been exposed to immunosuppressants and 35% (n = 187) of patients received at least one anti-TNF agent. Forty-three percent (n = 230) of patients underwent at least one intestinal resection. The overall mortality rate was 0.93% and the SMR was 1.6 [0.5-3.8] (p = 0.20). Five cancers were reported with a crude cancer incidence rate of 1.1% and an SIR of 3.3 [1.2-7.0] (p = 0.01). In a multivariate Cox model, ileal (HR, 1.87 [1.09-3.21], p = 0.022) or ileocolonic (HR, 1.54 [1.01-2.34], p = 0.042) and perianal lesions at diagnosis (HR, 1.81 [1.13- 2.89], p = 0.013) were significantly associated with complicated behavior. CONCLUSION: About 80% of patients with pediatric-onset CD presented extensive ileocolonic disease during follow-up. The majority of patients evolved to complicated behavior. Surgery, cancer and mortality were observed in 43%, 0.9% and 0.9% of patients, respectively.
Authors: Lester Tsai; Christopher Ma; Parambir S Dulai; Larry J Prokop; Samuel Eisenstein; Sonia L Ramamoorthy; Brian G Feagan; Vipul Jairath; William J Sandborn; Siddharth Singh Journal: Clin Gastroenterol Hepatol Date: 2020-10-27 Impact factor: 13.576
Authors: Neera Gupta; Robert H Lustig; Howard Andrews; Ranjana Gokhale; Alka Goyal; Ashish S Patel; Stephen Guthery; Francisco Sylvester; Leah Siebold; Cheng-Shiun Leu Journal: Inflamm Bowel Dis Date: 2021-05-17 Impact factor: 7.290
Authors: Joel R Rosh; Dan Turner; Anne Griffiths; Stanley A Cohen; Douglas Jacobstein; Omoniyi J Adedokun; Lakshmi Padgett; Natalie A Terry; Christopher O'Brien; Jeffrey S Hyams Journal: J Crohns Colitis Date: 2021-11-08 Impact factor: 9.071