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[To grow up with Crohn's disease]
Judit Kovács1, Anikó Nagy, András Szabó
1Fővárosi Önkormányzat Heim Pál Gyermekkórháza Gasztroenterológiai és Nefrológiai Osztály, Budapest. birokovacs@hdsnet.hu
Insights
Childhood-onset Crohn's disease in Hungary shows characteristics similar to other European countries. Early immunomodulatory therapy is key for favorable outcomes in pediatric Crohn's disease patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Context:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Childhood-onset CD presents unique challenges in diagnosis and management.
- Understanding disease characteristics in specific populations is crucial for effective treatment strategies.
Purpose:
- To characterize the clinical features and disease course of childhood-onset Crohn's disease in Hungarian patients.
- To identify factors influencing disease progression and treatment outcomes.
- To compare Hungarian pediatric CD patients with international cohorts.
Summary:
- A retrospective review of 81 Hungarian patients with childhood-onset Crohn's disease (diagnosed before age 18) was conducted.
- Key findings include a male predominance (62%), significant diagnostic lag (11.36 months), and high initial disease activity.
- Common initial manifestations included ileal involvement (87%), stricturing/penetrating disease (27%), and malnutrition (23.5%).
- Treatment involved steroids (84%) and azathioprine (62%); biologic therapy was unavailable.
- At age 18, disease activity, malnutrition, and growth failure significantly improved, with 31% undergoing surgery.
Impact:
- This study highlights that childhood-onset Crohn's disease in Hungary shares similarities with European cohorts.
- Prolonged diagnostic delays and high initial disease burden necessitate aggressive early therapeutic approaches.
- The findings underscore the importance of early immunomodulatory therapy for improving long-term outcomes in pediatric Crohn's disease.
Objective:
To assess the characteristics and course of childhood-onset Crohn's disease among Hungarian patients.
Methods:
Records of 81 patients admitted between 1984 and 2006 and treated at least for one year until the 18th year of age were reviewed.
Results:
There was a 62% male dominance and a rate of 12.5% of familial cases. The diagnostic lag was 11.36 (1-96) months. The mean age was 13.6 years (4-17), the activity index was 37.88 (5-80) at diagnosis and the initial frequencies were as follows: ileal affection 87%, stricturing and penetrating forms 27%, perianal manifestation 26%, giant cells or granuloma formation 47%, malnutrition 23,5%, growth failure 11%. Steroid therapy and azathioprin treatment were given in 84% and 62% of the patients, respectively. Biologic treatment was not possible during the study period. 31% of the patients underwent surgery (abdominal surgery 20%, perianal surgery 11%). When patients reached the 18th year of age the mean activity index decreased to 6.63 (0-35), the rate of malnutrition to 9.9% and that of growth failure to 2.5%. All these changes were statistically significant.
Conclusions:
Characteristics of childhood-onset Crohn's disease in Hungary are similar to those obtained in other European countries. The prolonged diagnostic lag, the high initial activity index, the granuloma formation and the stricturing/penetrating behavior may predict subsequent complications and need for surgery, and, therefore, justify intense initial therapy. The early introduction of immunomodulatory therapy affects favorably the course of illness.
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