Related Experiment Videos
[Severe Crohn's disease in children. Retrospective study of 38 cases]
E Sadoun1, O Goulet, J F Mougenot
1Service de Gastroentérologie et Nutrition, Hôpital Necker-Enfants-Malades, Paris.
Insights
Severe Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Nutrition in Pediatrics
Context:
- Severe Crohn's disease (CD) in children presents significant challenges.
- Long-term outcomes and treatment efficacy in pediatric CD require further investigation.
- Understanding disease patterns and treatment responses is crucial for improving patient care.
Purpose:
- To retrospectively analyze the long-term outcomes of severe pediatric Crohn's disease.
- To evaluate the effectiveness of various treatments, including corticosteroids, azathioprine, continuous enteral feeding (CEF), and parenteral nutrition (PN).
- To assess disease recurrence, reoperation rates, growth, and quality of life.
Summary:
- This study followed 38 children with severe CD for a mean of 6 years.
- Treatments included corticosteroids, azathioprine, CEF, and PN, with varying recurrence and reoperation rates based on disease location.
- Significant improvements in weight, height, and quality of life were observed, with a 70% decrease in the activity index.
Impact:
- Findings highlight the long-term benefits of nutritional support (CEF/PN) and medical therapies in managing severe pediatric CD.
- Identifies factors influencing disease recurrence and reoperation rates, guiding surgical decisions.
- Demonstrates substantial improvements in growth and quality of life, underscoring the importance of comprehensive management strategies.
Abstract:
Thirty-eight children presenting with severe Crohn's disease (CD) were studied retrospectively over a mean period of 6 years. The severity of CD was estimated according to an activity score. This was initially 66 +/- 19 reaching 100 in 16% of cases. Initial involvement included ileon and large intestine only (n = 23), large intestine (n = 11) and ileon only (n = 4), with upper GI tract or perineal involvement in 32 and 75% of cases respectively. The treatments consisted of corticosteroids (n = 34), azathioprine (n = 11), continuous enteral feeding (CEF) (n = 25), parenteral nutrition (PN) (n = 30). Mean recurrence rates per patient and per year were 0.6 in the groups including ileon and large intestine or the large intestine only and 0.3 in the ileal group. A surgical resection was performed in 20 cases with a mean rate of reoperation of 40% at 5 years. Reoperations were necessary only in the group involving the ileon and large intestine. Mean weight catch-up in 3 months and height growth speed were 6 kg and 1.7 to 3.1 cm/year under CED and/or PN. After a 6 year follow-up the activity index was decreased by 70% with a quality of life considered to be good in 60% of cases.