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Outcomes of Pediatric Fistulising Perianal Crohn's Disease
Bilge S Akkelle1, Ozlem K Sengul1, Burcu Volkan1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Marmara University School of Medicine, Istanbul, Turkey.
Insights
Fistulising perianal Crohn's disease (fpCD) is increasingly diagnosed in children. Early detection via physical exams and MRI is crucial for managing this severe form of pediatric Crohn's disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Crohn's Disease Pathophysiology
Background:
- Perianal disease is a significant factor in pediatric Crohn's disease behavior.
- Previous reports may have underestimated the prevalence of perianal involvement in pediatric Crohn's patients.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric patients with fistulising perianal Crohn's disease (fpCD).
- To understand the diagnostic challenges and treatment strategies for fpCD in children.
Main Methods:
- Retrospective review of 149 pediatric inflammatory bowel disease patients.
- Detailed data compilation for 50 pediatric Crohn's disease patients with at least 18 months follow-up.
- Inclusion of clinical, endoscopic, laboratory, and radiologic data, including MRI.
Main Results:
- 52% of pediatric Crohn's patients were diagnosed with fpCD, with 38% presenting at disease onset.
- Perianal MRI identified fpCD in over half of patients lacking external orifices.
- Pediatric fpCD patients exhibited higher disease activity, elevated platelet counts, lower albumin, and more granulomas compared to non-fistulising patients.
Conclusions:
- Fistulising perianal Crohn's disease is more prevalent in pediatric populations than previously thought.
- A severe disease course may indicate a higher risk for developing fpCD.
- Enhanced physical examination and perianal MRI are vital for early detection and altered treatment strategies in pediatric fpCD.
Background:
Perianal disease is reported more widely in pediatric Crohn patients than in the past, and has been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn's disease (fpCD) in the pediatric age group.
Methods:
A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled.
Results:
Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients had a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infliximab.
Conclusion:
Fistulising perianal Crohn's disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.
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