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Pediatric perianal Crohn's disease behavior in the era of biologic therapy
S De La Puente1, R Espinosa Góngora1, H Souto Romero1
1Pediatric Surgery Department. Hospital Infantil Universitario Niño Jesús. Madrid.
Insights
Pediatric Crohn's disease (CD) with perianal disease (PD) requires aggressive treatment, often involving biological therapies. Close nutritional monitoring is essential for growth and development in these patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Therapeutics
Background:
- Perianal disease (PD) is a challenging manifestation of pediatric Crohn's disease (CD).
- Understanding the behavior of PD and treatment outcomes is crucial for optimizing patient care.
- Biological therapies have emerged as a significant treatment modality for complex CD cases.
Purpose of the Study:
- To characterize the clinical behavior of perianal Crohn's disease in pediatric patients.
- To evaluate the efficacy and role of biological therapy in managing pediatric perianal CD.
- To identify factors associated with disease progression and treatment response.
Main Methods:
- Retrospective analysis of pediatric CD patients (2017-2021) with a minimum 6-month follow-up.
- Comparison of patients with and without perianal disease regarding baseline characteristics, disease extension, and treatment.
- Assessment of clinical and/or radiological improvement for defining good control of perianal disease.
Main Results:
- 15.2% of pediatric CD patients presented with perianal disease, including fistulizing and non-fistulizing types.
- Perianal disease was significantly associated with growth failure (p=0.003) and increased use of biological therapies (p=0.005).
- 80% of patients with perianal disease achieved good disease control with their received treatment, including a need for second-line biologics in some cases.
Conclusions:
- Pediatric Crohn's disease patients with perianal involvement necessitate more intensive treatment strategies.
- Biological therapies play a pivotal role in the current management of pediatric perianal CD.
- Comprehensive nutritional assessment is vital to support optimal growth and development in these patients.
Aim Of The Study:
To describe perianal Crohn's disease behavior and the role of biological therapy in a sample of pediatric patients.
Methods:
A retrospective study of pediatric patients with Crohn's disease (CD) treated in our institution from 2017 to 2021, with a minimum follow up period of 6 months, was conducted. Patients were divided whether they had perianal disease (PD) or not. Baseline characteristics, extension of disease, growth failure rate, aggressive pattern rate, use of biological therapy and need for surgery, among other variables, were compared between both groups. Clinical and/or radiological improvement in the last 6 months of follow up was considered good control of PD.
Results:
Seventy eight pediatric patients with CD were included. Median age at diagnosis was 10.5 years, and median follow up time was 3.8 years. 64.1% patients were male. Of all, 15 (19.2%) had perianal disease, of which 10 had fistulizing findings and 5 had non fistulizing findings. PD was presented at diagnosis in 8 patients, and the rest developed it in a median time of 1 year from diagnosis. PD was associated with growth failure (p = 0.003), use of biological therapies (p = 0.005), and need for second line of biologics (p = 0.005). Most patients (12/15, 80%) had good control of PD with the treatment received.
Conclusions:
CD patients with PD seem to need a more aggressive treatment, with biological therapies playing a key role for its handling nowadays. These patients require close nutritional evaluation that ensures proper development and growth.
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