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Younger age at diagnosis is associated with panenteric, but not more aggressive, Crohn's disease
Eran Israeli1, John D Ryan2, Leigh-Anne Shafer2
1IBD Unit, Department of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
Insights
Pediatric Crohn's disease (CD) may appear more extensive initially due to diagnostic methods, but children with CD do not experience more complicated disease or require more surgery than adults. This finding impacts how CD outcomes are assessed across age groups.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Pediatric Crohn's disease (CD) is often perceived as more aggressive with greater upper GI involvement compared to adult CD.
- Previous studies have not adequately controlled for variations in diagnostic testing methods across age groups.
- A need exists to clarify if childhood-onset CD truly has a different disease course than adult-onset CD.
Purpose of the Study:
- To investigate and compare the long-term outcomes of Crohn's disease diagnosed in pediatric versus adult populations.
- To determine if observed differences in disease phenotype and progression are attributable to intrinsic disease characteristics or variations in diagnostic approaches.
- To provide evidence-based insights for the management and prognosis of pediatric CD.
Main Methods:
- A retrospective analysis of 571 patients with CD (451 with complete data) treated at a single referral center from 1993-2012.
- Categorization of patients based on age at diagnosis using the Montreal classification (A1: <17 years, A2: 17-40 years, A3: >40 years).
- Assessment of diagnostic imaging modalities used, disease phenotype (including upper GI and ileocolonic involvement), disease behavior (complicated vs. uncomplicated), and surgical rates over time.
Main Results:
- Within one year of diagnosis, pediatric CD patients (A1) showed higher rates of upper GI and ileocolonic (L3) involvement, partly explained by more extensive imaging.
- Despite more imaging, A1 patients had a lower initial prevalence of complicated disease compared to older groups (A2, A3).
- Over a median follow-up of 11.1 years, complicated disease behavior (B2/B3) was similar across age groups, but A1 patients had significantly lower rates of IBD-related abdominal surgery than A2 patients.
Conclusions:
- Diagnostic patterns, particularly imaging utilization, must be considered when comparing Crohn's disease phenotypes across different age cohorts.
- Children diagnosed with CD face an increased risk of panenteric disease but do not exhibit a higher likelihood of disease complications or surgical intervention compared to adults.
- The study suggests that childhood-onset CD may not be inherently more aggressive in terms of long-term complications or surgical needs.
Background & Aims:
Crohn's disease (CD) diagnosed in pediatric patients has been reported to have a more aggressive phenotype and course, with a greater prevalence of upper gastrointestinal involvement, than in adults. However, studies have not accounted for differences in diagnostic tests. We aimed to discern whether, in fact, CD diagnosed in childhood has a different outcome than CD diagnosed in adults.
Methods:
We performed comprehensive medical chart reviews of 571 patients with CD (451 with complete data) who were followed in a single referral inflammatory bowel disease clinic in Winnipeg, Canada, from 1993-2012. For specific time intervals, we determined types and numbers of imaging studies performed and parameters of disease phenotype, including age at diagnosis according to the Montreal classification (A1 diagnosed <17 years of age, A2 diagnosed 17-40 years, and A3 diagnosed >40 years).
Results:
Within 1 year of diagnosis, a higher proportion of A1 patients had upper gastrointestinal involvement and ileocolonic (L3) disease than A2 or A3 patients. These differences could be partly accounted for by the diagnostic tests performed during this time period. Although A1 patients underwent more extensive imaging studies, they had a lower prevalence of complicated disease, particularly compared with A3 patients. After a median follow-up period of 11.1 years, complicated disease behavior (B2 [structuring] or B3 [penetrating]) was similar among the 3 groups. Nonetheless, at the end of the study period, rates of inflammatory bowel disease-related abdominal surgery were significantly lower for A1 than A2 patients (odds ratio, 0.63; 95% confidence interval, 0.41-0.98) but not for A3 patients (odds ratio, 0.71; 95% confidence interval, 0.40-1.27).
Conclusions:
On the basis of a database analysis of different age groups of patients with CD, studies of disease phenotypes among different cohorts should account for different patterns of diagnostic imaging evaluation. Our data show that although children are at increased risk of panenteric disease, they are not more likely to have more complicated disease or undergo surgery than adults.
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