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Risk Factors for Surgery in Pediatric Patients with Crohn's Disease
Rayna Rumenova Shentova-Eneva1, Denitza Kofinova1, Petyo Hadzhiyski1
1Department of Gastroenterology and Hepatology, University Children's Hospital "Prof. Ivan Mitev," Medical University of Sofia, Sofia, Bulgaria.
Insights
Pediatric Crohn's disease patients, especially females with stricturing or perianal disease, face a higher risk of surgery. Early identification of these factors can guide more aggressive treatment strategies.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Pediatric Crohn's disease (CD) often presents aggressively with a higher likelihood of complications requiring surgery compared to adult CD.
- Identifying risk factors for surgical intervention in pediatric CD is crucial for timely and effective management.
Purpose of the Study:
- To identify factors associated with an increased risk of surgical intervention in pediatric patients diagnosed with Crohn's disease.
Main Methods:
- A retrospective review of medical records for 57 pediatric CD patients was conducted.
- Variables analyzed included sex, age, symptoms, disease location/severity, extraintestinal manifestations, and antibodies.
- Statistical analysis involved univariate (Mann-Whitney, Fisher's exact) and multivariate binary logistic regression.
Main Results:
- 28.1% of pediatric CD patients required surgery.
- Female sex, specific disease behaviors (B2, B2B3), and perianal disease at diagnosis were significantly associated with surgical intervention.
- Independent risk factors for surgery included stricturing disease (B2/B2B3) and perianal disease at diagnosis.
Conclusions:
- Female pediatric CD patients with stricturing or perianal disease are at elevated risk for surgery.
- These high-risk patients may benefit from consideration of more aggressive medical treatment approaches.
Objective:
Pediatric Crohn's disease (CD) has a more aggressive phenotype and course than in adults. Many patients develop complications that require surgery. The aim of this study was to identify the factors associated with increased risk for surgical intervention in pediatric patients with CD.
Subjects And Methods:
This study is a retrospective review of medical records. We analyzed the following variables: sex, age at diagnosis, presenting symptoms, duration of symptoms before diagnosis, disease location and severity, the presence of extraintestinal manifestations, and the presence of anti-Saccharomyces cerevisiae antibodies. Univariate analysis using the Mann-Whitney test and Fisher's exact test was performed to detect the factors associated with surgery. Potential risk factors with p < 0.05 were further analyzed using a multivariate binary logistic regression model.
Results:
Fifty-seven patients (27 girls and 30 boys) were included in the analysis. More than one-fourth of them (28.1%) required surgical management. Female sex (p = 0.043), disease behavior (p = 0.012), and the presence of perianal disease at diagnosis (p < 0.001) were the variables associated with surgical intervention. Stricturing disease (B2) (odds ratio [OR], 24.944; p = 0.016), stricturing and penetrating disease (B2B3) (OR, 28.276; p = 0.011), and the presence of perianal disease at diagnosis (OR, 95.802; p = 0.001) were independent risk factors for surgery. Female sex was associated with surgery without being an independent risk factor.
Conclusion:
Females with B2 or B2B3 or the presence of perianal disease at diagnosis are at a higher risk for surgery and should be considered for more aggressive medical treatments.
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