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Presentation and disease course in early- compared to later-onset pediatric Crohn's disease
Neera Gupta1, Alan G Bostrom, Barbara S Kirschner
1UCSF Children's Hospital, University of California, San Francisco, California 94143-0136, USA.
Insights
Children diagnosed with Crohn's disease (CD) at 6-17 years old experience a more complex disease course than those diagnosed at 0-5 years old. Early-onset CD in very young children may indicate a distinct disease phenotype requiring tailored management strategies.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Pediatrics
Background:
- The relationship between age at diagnosis and disease progression in pediatric Crohn's disease (CD) is not well-established.
- Understanding these differences is crucial for effective management strategies.
Purpose of the Study:
- To compare the clinical presentation and disease course of Crohn's disease in children diagnosed between 0-5 years versus 6-17 years of age.
- To identify potential differences in disease phenotype and treatment responses based on age at diagnosis.
Main Methods:
- Analysis of uniform data from 989 consecutive pediatric CD patients diagnosed between 2000 and 2003.
- Utilized the Pediatric IBD Consortium Registry, accounting for patient follow-up duration in statistical analyses.
Main Results:
- Patients aged 6-17 years presented with more abdominal pain, weight loss, and fever, while younger patients (0-5 years) had more rectal bleeding.
- Older patients (6-17 years) were more likely to receive various medications, including antibiotics, immunomodulators, infliximab, and corticosteroids.
- The 6-17 year age group exhibited a higher risk for developing complications such as abscesses, fistulas, strictures, and perianal fissures.
Conclusions:
- Pediatric Crohn's disease patients diagnosed at 6-17 years old appear to have a more complicated disease course compared to those diagnosed at 0-5 years old.
- The 0-5 year age group may represent a unique disease phenotype, potentially benefiting from distinct management approaches.
- Further long-term prospective studies are necessary to validate these findings and inform clinical practice.
Background:
The relationship between the age at diagnosis and disease course is poorly defined in children with Crohn's disease (CD). We examined the presentation and course of disease in patients 0-5 compared to 6-17 yr of age at diagnosis.
Methods:
We analyzed uniform data from 989 consecutive CD patients collected between January 2000 and November 2003, and stored in the Pediatric IBD Consortium Registry. The statistical tests account for the length of follow-up of each patient.
Results:
In total, 98 patients (9.9%) were of 0-5 yr of age at diagnosis. The mean follow-up time was 5.6 +/- 5.0 yr in the younger group and 3.3 +/- 2.8 yr in the older group (P < 0.001). Race/ethnicity differed by the age group (P= 0.015); a larger proportion of the younger group was Asian/Pacific Islander or Hispanic, and a larger proportion of the older group was African American. The initial classification as ulcerative colitis or indeterminate colitis was more common among the 0-5 yr of age group (P < 0.001). The 6-17 yr of age patients presented with more abdominal pain (P < 0.001), weight loss (P= 0.001), or fever (P= 0.07), while the 0-5 yr of age patients presented with more rectal bleeding (P= 0.008). The 6-17 yr of age patients were more likely to be treated with antibiotics (P < 0.001), 6-mercaptopurine/azathioprine (P < 0.001), infliximab (P= 0.001), or corticosteroids (P= 0.0006). The 6-17 yr of age patients had a higher cumulative incidence of treatment with 5-aminosalicylates (P= 0.009) or methotrexate (P= 0.04). The risk for developing an abscess (P= 0.001), a fistula (P= 0.02), a stricture (P= 0.05), or a perianal fissure (P= 0.06) was greater in the 6-17 yr of age patients.
Conclusions:
The 6-17 yr of age patients with CD appear to have a more complicated disease course compared to 0-5 yr of age children. The 0-5 yr of age group may represent a unique disease phenotype and benefit from different approaches to management. Long-term prospective studies are required to validate these findings.
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