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Published on: October 29, 2014
Pediatric Crohn's disease: risk factors for postoperative recurrence
R N Baldassano1, P D Han, W C Jeshion
1Children's Hospital of Philadelphia, Department of Pediatrics, Pennsylvania 19104-4283, USA.
Insights
Pediatric Crohn's disease recurrence after surgery is high, especially with colonic disease or severe symptoms. Postoperative 6-mercaptopurine (6-MP) may benefit children with aggressive disease, and height growth improves post-surgery.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease recurrence after surgery in children is not well-defined.
- Understanding postoperative outcomes is crucial for pediatric IBD management.
Purpose of the Study:
- To examine the postoperative course of pediatric Crohn's disease.
- To identify factors predicting early postoperative recurrence in children.
Main Methods:
- Retrospective analysis of 100 resective surgeries in 79 children (1978-1996).
- Multivariable analysis of clinical recurrence predictors.
- Comparison of preoperative and postoperative height-for-age z scores.
Main Results:
- 5-year recurrence rate reached 60%.
- Colonic Crohn's disease correlated with shorter recurrence-free interval (1.2 yrs).
- High disease activity and preoperative 6-mercaptopurine (6-MP) use predicted higher recurrence.
Conclusions:
- High recurrence rates in pediatric Crohn's disease are linked to disease severity, colonic involvement, and preoperative 6-MP use.
- Postoperative 6-MP prophylaxis is recommended for children with aggressive disease.
- Intestinal resection improved height growth in pediatric patients.
Objective:
Postoperative recurrence of Crohn's disease in adults has been extensively studied; however, the course of Crohn's disease after surgery in children has not been well defined. The aim of this study was to examine the postoperative course of pediatric Crohn's disease and the factors that may predict early postoperative recurrence.
Methods:
We identified 100 resective surgeries in 79 children with Crohn's disease seen at the Children's Hospital of Philadelphia between 1978 and 1996. A retrospective, multivariable analysis of factors potentially influencing postoperative clinical recurrence was performed. Preoperative and postoperative height measurements were compared, and z scores were computed for height-for-age. Two-tailed t test was used for the analysis.
Results:
Clinical recurrence rates were 17% at 1 yr, 38% at 3 yr, and 60% at 5 yr. Patients with colonic Crohn's disease had a significantly shorter postoperative recurrence-free interval (median 1.2 yr) than patients with ileocecal (median 4.4 yr) or diffuse disease (median 3.0 yr) (p = 0.01). On multivariable analysis, a high Pediatric Crohn's Disease Activity Index at the time of surgery (p = 0.01) and preoperative use of 6-mercaptopurine (6-MP) (p < 0.005) were also independently associated with higher postoperative recurrence rates. There was a significant improvement in z scores for height (p = 0.04) after surgery.
Conclusions:
In children undergoing resective surgery for Crohn's disease, high rates of postoperative Crohn's disease recurrence are associated with severe disease at the time of surgery, colonic Crohn's disease, and the preoperative use of 6-MP. Patients who require preoperative use of 6-MP are likely to suffer from a more aggressive disease and would benefit from postoperative 6-MP prophylaxis. Height growth was improved after intestinal resection for Crohn's disease.
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