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Published on: December 1, 2012
Risk factors for initial surgery in pediatric patients with Crohn's disease
Neera Gupta1, Stanley A Cohen, Alan G Bostrom
1UCSF Children's Hospital, University of California, San Francisco, California 94143-0136, USA.
Insights
Surgery is common in pediatric Crohn's disease, with 28% of patients needing intestinal resection within 10 years. Risk factors like female gender and disease complications increase surgical risk, while certain treatments may decrease it.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Outcomes in Children
Background:
- Crohn's disease frequently requires surgery in adults, with 10-year cumulative incidence rates of 40%-70%.
- Understanding surgical incidence and risk factors in pediatric Crohn's disease is crucial for effective management.
Purpose of the Study:
- To determine the cumulative incidence of intestinal resection in pediatric Crohn's disease patients.
- To identify risk factors associated with an increased or decreased likelihood of surgery in this population.
Main Methods:
- Retrospective analysis of uniform data from 989 pediatric Crohn's disease patients (age 0-17) across 6 centers.
- Data collected between 2000-2003 from the Pediatric IBD Consortium Registry.
- Kaplan-Meier estimates and Cox proportional hazards models were used to assess surgery incidence and risk factors.
Main Results:
- The cumulative incidence of surgery was 17% at 5 years and 28% at 10 years post-diagnosis.
- Factors associated with increased surgery risk included female gender, initial ulcerative colitis diagnosis, poor growth, abscess, fistula, and stricture development.
- Factors associated with decreased surgery risk included younger age at diagnosis (3-12 years), fever at presentation, and treatment with infliximab or 5-aminosalicylic acid.
Conclusions:
- Pediatric Crohn's disease has a significant cumulative incidence of surgery within 10 years.
- Identifying specific risk factors allows for risk stratification to guide therapy.
- Targeted therapeutic strategies may improve disease outcomes and reduce the need for intestinal resection in pediatric Crohn's disease.
Background & Aims:
The cumulative incidence of surgery ranges from 40%-70% at 10 years from the time of diagnosis of Crohn's disease in adults. We retrospectively determined the cumulative incidence of and risk factors for surgery (intestinal resection) in pediatric patients with Crohn's disease.
Methods:
Uniform data from 989 consecutive Crohn's disease patients (age 0-17 years at diagnosis), collected from 6 different pediatric centers between January 2000 and November 2003 and stored in the Pediatric IBD Consortium Registry, were analyzed.
Results:
Median follow-up time was 2.8 years (range, 1 day to 16.7 years). One hundred twenty-eight patients underwent surgery. Kaplan-Meier survival estimates of the cumulative incidence of surgery were 17% at 5 years and 28% at 10 years from the diagnosis of inflammatory bowel disease. Univariate Cox proportional hazards models showed leukocytosis (2.85 [hazard ratio]; P = .02), hypoalbuminemia (3.41; P = .05), and anti-Saccharomyces cerevisiae antibody (ASCA) positivity (3.43; P = .05) were associated with increased risk for surgery. Multivariate Cox models showed female gender (1.49; P = .03), initial diagnosis of ulcerative colitis (3.63; P < .0001), poor growth at presentation (2.16; P = .007), and abscess (1.90; P = .009), fistula (2.30; P = .0005), or stricture (3.41; P < .0001) development were associated with increased risk for surgery. Age 3-5 years (0.26; P = .01) or 6-12 years (0.62; P = .01) at diagnosis, fever at presentation (0.50; P = .03), and treatment with infliximab (0.36; P = .0005) or 5-aminosalicylic acid (0.44; P < .0001) were associated with decreased risk for surgery.
Conclusions:
Risk stratification during the course of Crohn's disease in pediatric patients will help to guide therapy that may improve the natural history of disease and decrease the need for surgery.
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