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[Over one year follow-up report for newly diagnosed pediatric Crohn's disease]
Xiang Gao1, Zhen-yu Shen, Min-hu Chen
1Department of Gastroenterology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Insights
Pediatric Crohn's disease (CD) often presents with growth issues, but immunosuppressant therapy, like 6-MP/AZA, can lead to remission and improved growth. This treatment is safe with careful monitoring.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Therapeutics
Context:
- Pediatric Crohn's disease (CD) presents unique challenges in diagnosis and management.
- Growth retardation is a significant concern in children diagnosed with CD.
- Understanding clinical characteristics and treatment responses is crucial for improving outcomes.
Purpose:
- To investigate the clinical features, treatment effectiveness, and outcomes of pediatric Crohn's disease (CD).
- To evaluate the impact of immunosuppressant therapy on disease activity and growth in pediatric CD patients.
- To assess the safety and efficacy of individualized treatment strategies.
Summary:
- A cohort of 20 pediatric CD patients (0.5-15 years) showed common symptoms including abdominal pain, fever, and diarrhea, with 50% experiencing growth retardation and 45% presenting with complicated disease behavior.
- Treatment with corticosteroids and 6-mercaptopurine/azathioprine (6-MP/AZA) led to complete remission in 82% of cases, with 40% achieving mucosal healing.
- At follow-up (mean 23 months), 75% achieved complete remission, and those who withdrew from corticosteroids showed catch-up growth, with 17% experiencing severe adverse effects from 6-MP/AZA.
Impact:
- Immunosuppressant therapy, particularly 6-MP/AZA, demonstrates potential to alter the natural history of pediatric CD.
- Early identification of growth retardation can serve as a diagnostic indicator for pediatric CD.
- Individualized treatment under close monitoring appears safe and effective for managing pediatric CD.
Objective:
To explore the clinical characteristics, therapeutic responses and outcomes of pediatric Crohn's disease (CD).
Methods:
From a hospital-derived incidence cohort, 20 Crohn's disease patients (aged 0.5 - 15 years old at diagnosis), diagnosed from 2003 to 2009, received a follow-up period of more than one year. The patients were phenotyped according to Montreal standards. PCDAI was introduced to assess the disease activity and the Hyams J rules adopted to evaluate the therapeutic efficacies. The treatment was individualized based on the overall evaluation of child.
Results:
Of these 20 patients, 55% were 7 - 12 years old at the diagnosis time. The male: female ratio was 1.5:1. At the time of diagnosis, the common manifestations included abdominal pain (95.0%), fever (80.0%) and diarrhea (80.0%). Growth retardation was detected in 50% of the cases. Complicated behavior was observed in 45% patients at diagnosis. The most frequent disease location at diagnosis was terminal ileum/colon (55%). Upper GI tract involvement was quite common in children (20%). Non-penetrating non-stricture (50%) behavior was most frequent at diagnosis. Ultimately, corticosteroids plus 6-MP/AZA treatment was administrated in 11 cases. Of these, 9 (82%) successfully withdrew the corticosteroids and maintained a complete remission. Colonoscopy was repeated in 6 complete remission cases and 4 of them achieved a complete mucosa healing. The mean follow-up period was 23 months (range: 12 - 59). At the endpoint of follow-up, 15 cases achieved a complete remission, 4 had a partial remission, 1 underwent operation and none of them died. The children who successfully withdrew from corticosteroids and achieved a complete remission could catch up the height of their age group. 6-MP/AZA associated severe adverse effects were reported at 17% in this group.
Conclusion:
Growth retardation is predominant in pediatric CD and it may provide diagnostic clues. Immunosuppressant therapy may improve the natural history of this disease. It is safe under close monitoring.
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