Amanda Ricciuto1, Martine Aardoom2, Esther Orlanski-Meyer3, Dan Navon3, Nicholas Carman4, Marina Aloi5, Jiri Bronsky6, Jan Däbritz7, Marla Dubinsky8, Séamus Hussey9, Peter Lewindon10, Javier Martín De Carpi11, Víctor Manuel Navas-López12, Marina Orsi13, Frank M Ruemmele14, Richard K Russell15, Gabor Veres16, Thomas D Walters1, David C Wilson17, Thomas Kaiser18, Lissy de Ridder2, Dan Turner3, Anne M Griffiths19. 1. IBD Centre, SickKids Hospital, University of Toronto, Toronto, Canada. 2. Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, the Netherlands. 3. Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Israel. 4. Children's Hospital of Eastern Ontario, IBD Centre, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. 5. Pediatric Gastroenterology Unit, Sapienza University of Rome, Umberto I Hospital, Rome, Italy. 6. Department of Pediatrics, University Hospital Motol, Prague, Czech Republic. 7. University Medical Center Rostock, Department of Pediatrics, Rostock, Germany; Queen Mary University of London, The Barts and the London School of Medicine and Dentistry, Blizard Institute, Center for Immunobiology, London, United Kingdom. 8. Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine, Mount Sinai, New York. 9. National Children's Research Centre, Royal College of Surgeons of Ireland and University College Dublin, Dublin, Ireland. 10. University of Queensland, Brisbane, Australia. 11. Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain. 12. Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Spain. 13. Pediatric Gastroenterology, Hepatology and Transplant Unit, Hospital Italiano de Buenos Aires, Argentina. 14. Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Service de Gastroentérologie Pédiatrique, Institute IMAGINE Inserm U1163, Paris, France. 15. Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom. 16. Pediatric Institute-Clinic, University of Debrecen, Hungary. 17. Child Life and Health, University of Edinburgh, Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom. 18. Department of General Pediatrics, University Hospital Münster, Germany. 19. IBD Centre, SickKids Hospital, University of Toronto, Toronto, Canada. Electronic address: anne.griffiths@sickkids.cal.
Abstract
BACKGROUND & AIMS: A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. METHODS: A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. RESULTS: Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. CONCLUSIONS: These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.
BACKGROUND & AIMS: A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. METHODS: A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. RESULTS: Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. CONCLUSIONS: These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.
Authors: Maria M E Jongsma; Stephanie A Vuijk; Martinus A Cozijnsen; Merel van Pieterson; Obbe F Norbruis; Michael Groeneweg; Victorien M Wolters; Herbert M van Wering; Iva Hojsak; Kaija-Leena Kolho; Michiel P van Wijk; Sarah T A Teklenburg-Roord; Tim G J de Meij; Johanna C Escher; Lissy de Ridder Journal: Eur J Pediatr Date: 2022-06-08 Impact factor: 3.860