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Factors that determine risk for surgery in pediatric patients with Crohn's disease
Marc E Schaefer1, Jason T Machan, David Kawatu
1Pediatric Inflammatory Bowel Disease Collaborative Research Group, Hartford, Connecticut, USA.
Insights
The 5-year risk of bowel surgery for pediatric Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Outcomes in Children
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease affecting children.
- Surgery is a common complication and treatment modality for pediatric CD.
- Understanding surgical incidence and risk factors is crucial for patient management.
Purpose of the Study:
- To determine the incidence of Crohn's disease (CD)-related surgery in pediatric patients.
- To evaluate the impact of early immunomodulator therapy on surgical risk in pediatric CD.
Main Methods:
- Analysis of a multi-center, inception cohort of 854 pediatric CD patients.
- Data collected from 2002 to 2008 through the Pediatric Inflammatory Bowel Disease Collaborative Research Group.
- Assessment of cumulative risks for bowel, non-bowel, and all CD-related surgeries at 1 and 5 years post-diagnosis.
Main Results:
- Overall, 9% of pediatric CD patients underwent CD-related surgery within 5 years.
- Cumulative 5-year risks: 13.8% for bowel surgery, 4.5% for non-bowel surgery, 17.7% for all CD-related surgeries.
- Factors increasing bowel surgery risk included older age at diagnosis, greater disease severity, and stricturing/penetrating disease.
Conclusions:
- The 5-year cumulative risk of bowel surgery in pediatric CD is lower than in some adult and pediatric studies.
- Early immunomodulator therapy (within 30 days of diagnosis) did not significantly alter the 5-year risk of surgery.
- Disease location in the transverse colon to rectum was associated with a decreased risk of surgery.
Background & Aims:
We examined the incidence of Crohn's disease (CD)-related surgery in a multi-center, inception cohort of pediatric patients with CD. We also examined the effect of starting immunomodulator therapy within 30 days of diagnosis.
Methods:
Data from 854 children with CD from the Pediatric Inflammatory Bowel Disease Collaborative Research Group who were diagnosed with CD between 2002 and 2008 were analyzed.
Results:
Overall, 76 (9%) underwent a first CD-related surgery, 57 (7%) underwent a first bowel surgery (bowel resection, ostomy, strictureplasty, or appendectomy), and 19 (2%) underwent a first non-bowel surgery (abscess drainage or fistulotomy). The cumulative risks for bowel surgery, non-bowel surgery, and all CD-related surgeries were 3.4%, 1.4%, and 4.8%, respectively, at 1 year after diagnosis and 13.8%, 4.5%, and 17.7%, respectively, at 5 years after diagnosis. Older age at diagnosis, greater disease severity, and stricturing or penetrating disease increased the risk of bowel surgery. Disease between the transverse colon and rectum decreased the risk. Initiation of immunomodulator therapy within 30 days of diagnosis, sex, race, and family history of inflammatory bowel disease did not influence the risk of bowel surgery.
Conclusions:
In an analysis of pediatric patients with CD, the 5-year cumulative risk of bowel surgery was lower than that reported in recent studies of adult and pediatric patients but similar to that of a recent retrospective pediatric study. Initiation of immunomodulator therapy at diagnosis did not alter the risk of surgery within 5 years of diagnosis.
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