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Perianal Pediatric Crohn Disease Is Associated With a Distinct Phenotype and Greater Inflammatory Burden
Amit Assa1, Michal Amitai, Mary-Louise Greer
1*Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Hospital, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel †Department of Radiology, Sheba Medical Center, Tel-Hashomer, Israel ‡Department of Diagnostic Imaging, Hospital for Sick Children §Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada ||Pediatric Radiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel ¶Department of Radiology, Hospital Regional Universitario Carlos Haya, Malaga, Spain #Electroradiology Department, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Cracow, Poland **Department of Radiology, University of Munich, Munich, Germany ††Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA ‡‡Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH §§Department of Radiology, Connecticut Children's Medical Center, Hartford, CT ||||Department of Radiology, Schneider Children's Hospital, Petah Tikva, Israel ¶¶Diagnostic Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel ##Division of Gastroenterology, Hospital for Sick Children, Toronto, Ontario, Canada ***Institute of Gastroenterology, Nutrition and Liver Disease, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Perianal Crohn disease (pCD) in children is linked to more severe outcomes, including reduced growth and higher inflammation. Fistulizing pCD in pediatric patients indicates distinct features and increased inflammatory burden.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Crohn Disease Pathophysiology
Background:
- Limited data exist on outcomes for children with perianal Crohn disease (pCD).
- Perianal involvement in pediatric Crohn disease often influences treatment decisions, including early biologic use.
- Understanding pCD's impact is crucial for managing pediatric inflammatory bowel disease.
Purpose of the Study:
- To determine if perianal Crohn disease (pCD) in children is associated with more severe disease outcomes.
- To compare the clinical, endoscopic, and radiologic features of pediatric Crohn disease with and without perianal involvement.
Main Methods:
- Data were extracted from the prospective, multicenter ImageKids database.
- 246 children with Crohn disease were evaluated at enrollment, with 98 having repeat evaluations at 18 months.
- Comprehensive clinical, endoscopic, and radiologic assessments were performed.
Main Results:
- Children with pCD (24%) showed reduced weight/height z-scores, higher disease activity, lower serum albumin, and increased inflammation on MRE.
- Perianal Crohn disease was associated with more rectal and jejunal involvement and a higher prevalence of granulomas.
- Patients with only skin tags/fissures had similar characteristics to those without perianal findings.
Conclusions:
- Pediatric patients with fistulizing perianal Crohn disease exhibit distinct phenotypic features.
- Fistulizing pCD in children is associated with a greater inflammatory burden.
- These findings highlight the importance of recognizing perianal disease in pediatric Crohn disease management.
Objectives:
Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults.
Methods:
Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months.
Results:
Of the 234 included patients (mean age 14.2 ± 2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ± 0.7 vs 4.5 ± 0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings.
Conclusions:
Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.
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