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Natural history of pediatric Crohn's disease: a population-based cohort study
Gwenola Vernier-Massouille1, Mamadou Balde, Julia Salleron
1Registre des Maladies inflammatoires chroniques de l'Intestin du Nord Ouest de la France EPIMAD, Service d'Hépato-Gastroentérologie, Hôpital Claude Huriez, Lille, France.
Insights
Pediatric Crohn's disease often progresses to severe, extensive disease. Early immunosuppressive therapy, like azathioprine, may reduce the need for surgery in children with Crohn's disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- The natural history of pediatric Crohn's disease (CD) requires further elucidation.
- Risk factors leading to surgery in pediatric CD are not well-defined.
Purpose of the Study:
- To describe the natural history of pediatric Crohn's disease.
- To identify risk factors associated with surgical intervention in children with CD.
Main Methods:
- A geographically derived incidence cohort of 404 pediatric CD patients (0-17 years) diagnosed between 1988-2002.
- Minimum follow-up of 2 years, with median follow-up of 84 months.
- Multivariate Cox models used to assess risk factors for surgery.
Main Results:
- Disease extension occurred in 31% of pediatric CD patients during follow-up.
- Surgery incidence was 20% at 3 years and 34% at 5 years post-diagnosis.
- Structuring behavior at diagnosis and corticosteroid use increased surgery risk; azathioprine use decreased surgery risk.
Conclusions:
- Pediatric Crohn's disease frequently presents with severe, extensive, and complicated disease phenotypes.
- Immunosuppressive therapy, particularly azathioprine, shows potential to alter the disease course and reduce surgical necessity.
- Early intervention with immunosuppressants may improve outcomes for pediatric Crohn's disease patients.
Background & Aims:
The natural history of pediatric Crohn's disease and risk factors necessitating surgery have not been thoroughly described.
Methods:
In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 404 Crohn's disease patients (ages, 0-17 years at diagnosis) with a follow-up time >or=2 years.
Results:
Median follow-up time was 84 months (range, 52-124 months). The most frequent disease location at diagnosis was the terminal ileum/colon (63%). Follow-up was characterized by disease extension in 31% of children. Complicated behavior was observed in 29% of children at diagnosis and 59% at follow-up. Kaplan-Meier survival estimates of the cumulative incidence of surgery were 20% at 3 years and 34% at 5 years from diagnosis. Multivariate Cox models showed that both structuring behavior at diagnosis (hazard ratio [HR], 2.54; 95% confidence interval [CI]: 1.58-4.01) and treatment with corticosteroids (HR, 2.98; 95% CI: 1.64-5.41) were associated with increased risk for surgery, whereas treatment with azathioprine (HR, 0.51; 95% CI: 0.33-0.78) was associated with decreased risk. Azathioprine was introduced earlier in the course of disease in patients not undergoing surgery than in patients requiring surgery.
Conclusions:
Pediatric Crohn's disease was characterized by frequent occurrence, with time, of a severe phenotype with extensive, complicated disease. Immunosuppressive therapy may improve the natural history of this disease and decrease the need for performing surgery.
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