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The need for surgery in pediatric patients with inflammatory bowel disease treated with biologicals
Kaija-Leena Kolho1, Anne Nikkonen2, Laura Merras-Salmio2
1Children's Hospital, Helsinki University Hospital HUS and Helsinki University, Helsinki, Finland. kaija-leena.kolho@helsinki.fi.
Insights
Biological treatment for pediatric inflammatory bowel disease (IBD) did not significantly reduce the need for intestinal surgery. Children needing surgery early were more likely to require it in adulthood, with disease duration being a key risk factor.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes of Biological Therapies
Background:
- Childhood-onset inflammatory bowel disease (IBD) often presents aggressively.
- Early intervention with biological therapies is a common strategy for pediatric IBD.
- Understanding long-term surgical outcomes in this population is crucial.
Purpose of the Study:
- To evaluate if initiating biological treatment in childhood reduces the long-term need for intestinal surgery in pediatric IBD patients.
- To identify risk factors associated with intestinal surgery in pediatric IBD patients undergoing biological therapy.
Main Methods:
- Retrospective, single-center cohort study of pediatric IBD patients initiated on biological therapy.
- Follow-up until first surgical procedure, re-operation in adulthood, or December 31, 2021.
- Data collected from a pediatric IBD registry and medical charts.
Main Results:
- 32.9% of 207 pediatric IBD patients (150 Crohn's disease, 31 ulcerative colitis, 26 IBD unclassified) underwent intestinal surgery.
- Patients with childhood surgery were more likely to require surgery in early adulthood.
- Longer disease duration at the start of biological treatment was the sole identified risk factor for surgery.
Conclusions:
- The risk of intestinal surgery remains high in pediatric IBD patients, even with biological treatment.
- The need for surgery often becomes apparent after patients transition to adult IBD care.
- Disease duration is a critical factor influencing surgical outcomes in pediatric IBD.
Purpose:
Inflammatory bowel disease (IBD) in childhood often presents with a more extensive and more aggressive disease course than adult-onset disease. We aimed to evaluate if biological treatment started in childhood decreases the need for intestinal surgery over time.
Methods:
This was a retrospective, single-center, cohort study. All pediatric patients with IBD initiated to biological therapy at the Children's Hospital, were included in the study and followed up to the first surgical procedure or re-operation in their adulthood or until 31.12.2021 when ≥ 18 of age. Data were collected from the pediatric registry of IBD patients with biologicals and medical charts.
Results:
A total of 207 pediatric IBD patients were identified [150 with Crohn´s disease (CD), 31 with ulcerative colitis (UC), 26 with IBD unclassified (IBDU)] of which 32.9% (n = 68; CD 49, UC 13, IBDU 6) underwent intestinal surgery. At the end of a median follow-up of 9.0 years (range 2.0-25.9), patients reached a median age of 21.4 years (range 18-36). Patients who had intestinal surgery in childhood were more likely to have IBD-related surgery also in early adulthood. The duration of the disease at induction of the first biological treatment emerged as the only risk factor, with a longer duration in the surgical group than in patients with no surgery.
Conclusion:
Despite initiation of biological treatment, the risk of intestinal surgery remains high in pediatric IBD patients and often the need for surgery emerges after the transition to adult IBD clinics.
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