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Upper gastrointestinal involvement in paediatric onset Crohn's disease: prevalence and clinical implications
S Crocco1, S Martelossi, N Giurici
1Department of Paediatrics, IRCCS Burlo Garofolo-University of Trieste, Italy.
Insights
Over half of pediatric Crohn's Disease (CD) patients have upper gastrointestinal (UGI+) involvement, presenting with earlier onset and more severe symptoms. While long-term outcomes are similar, UGI+ cases necessitate more aggressive treatment strategies for pediatric Crohn's Disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Gastrointestinal Oncology
Background:
- Crohn's Disease (CD) is a chronic inflammatory bowel disease.
- Upper gastrointestinal (UGI) involvement in pediatric CD is not fully characterized.
- Understanding UGI+ prevalence and implications is crucial for disease management.
Purpose of the Study:
- To evaluate the prevalence, characteristics, and implications of upper gastrointestinal involvement (UGI+) in pediatric Crohn's Disease (CD) patients.
- To compare disease severity and outcomes between pediatric CD patients with and without UGI+.
- To determine the impact of UGI+ on treatment approaches in pediatric CD.
Main Methods:
- Prospective study of 45 newly diagnosed pediatric CD patients.
- Assessment of CD localization at diagnosis and follow-up.
- Evaluation of clinical characteristics, disease severity (PCDAI), and growth parameters.
Main Results:
- 53.3% of pediatric CD patients exhibited UGI+ involvement.
- UGI+ patients presented with earlier onset (10.9 vs. 12.6 years) and higher initial PCDAI scores (41 vs. 25).
- UGI+ was associated with more symptoms, pancolitis, extraintestinal manifestations, and impaired growth at diagnosis, but similar long-term outcomes and growth catch-up.
Conclusions:
- Upper gastrointestinal localization is common in pediatric CD, affecting over half of patients.
- Pediatric CD patients with UGI+ experience earlier onset and more severe initial disease presentation.
- Despite similar long-term outcomes, UGI+ necessitates a more aggressive therapeutic strategy in pediatric CD management.
Background And Aims:
Our study evaluated the prevalence, the characteristics and implications of the upper gastrointestinal localisation (UGI+) in paediatric Crohn's Disease (CD) patients.
Methods:
This prospective study evaluated 45 newly diagnosed CD patients at diagnosis and follow up with respect to CD localisation.
Results:
All patients presented CD at the colon and/or ileum. In 24/45 patients (53.3%, 12 F and 12 M) an UGI+ involvement was also found. UGI+ patients had a younger age of onset (10.9 years versus 12.6 years; P<0.05). PCDAI at diagnosis was significantly higher in the UGI+ (41 vs. 25 P<0.01). UGI+ patients were overall more symptomatic. Pancolitis and extraintestinal manifestations were also more frequent (19/24 (80%) vs. 12/21 (57%) P<0.01). Growth was more impaired at diagnosis in UGI+ patients. By the end of the follow-up (mean 3 years, range 2 to 4) no significant difference was found in PCDAI (17 in UGI+ patients vs. 11 in UGI- P=NS), or the number of relapses. Weight and growth catch-up in UGI+ patients were comparable to UGI- ones. However, UGI+ patients required a more aggressive therapeutic approach.
Conclusion:
At least half of paediatric onset CD patients have an upper gastrointestinal localisation. UGI+ patients present an earlier onset and a more severe disease. The final outcome does not differ, but UGI+ patients require a more aggressive therapeutic approach.
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