Early predictors of intestinal complications in pediatric-onset Crohn's disease: A long-term cohort study in Taiwan
Yuh-Jue Chen1, Chi-Shan Tai2, Kai-Chi Chang2
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
Insights
The European Crohn's and Colitis Organization and European Society for Pediatric Gastroenterology Hepatology and Nutrition (ECCO-ESPGHAN) risk stratification effectively predicts intestinal complications in pediatric Crohn's disease. This tool aids in guiding early advanced therapy for better patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Prognostics
Background:
- Pediatric-onset Crohn's disease (CD) requires accurate prognostic factors for timely treatment initiation.
- Identifying predictors of long-term intestinal complications is crucial for managing pediatric CD patients.
Purpose of the Study:
- To assess the predictive value of clinical parameters for long-term intestinal complications in pediatric CD patients in Taiwan.
- To validate the ECCO-ESPGHAN risk stratification guidelines in a Taiwanese cohort.
Main Methods:
- Retrospective, single-center study of 53 pediatric CD patients diagnosed between 1999 and 2021.
- Baseline clinical variables and Pediatric Crohn's Disease Activity Index (PCDAI) were recorded.
- Patients were stratified into low, medium, and high-risk groups using ECCO-ESPGHAN guidelines.
Main Results:
- 8 patients (33.96%) developed intestinal complications over a median follow-up of 6.42 years.
- ECCO-ESPGHAN medium/high-risk groups showed a 4.71-fold increased risk of complications (p=0.023) versus the low-risk group, adjusted for PCDAI.
- The ECCO-ESPGHAN method had positive and negative predictive values of 48.15% and 80.77% for complications.
Conclusions:
- ECCO-ESPGHAN risk stratification is a valid early predictor of intestinal complications in Taiwanese pediatric CD patients.
- This stratification can guide clinical practice and the selection of early advanced therapies.
Purpose:
Identifying reliable prognostic factors for pediatric-onset Crohn's disease (CD) is important for guiding early treatment. This study aimed to evaluate the validity of various clinical parameters for predicting long-term intestinal complications in pediatric-onset CD patients with CD in Taiwan.
Methods:
This was a single-center, retrospective study. Patients diagnosed with CD under 18 years of age at our hospital between January 1999 and December 2021 were enrolled. The baseline clinical variables and the Pediatric Crohn's Disease Activity Index (PCDAI) were obtained. Patients were categorized into low-, medium-, or high-risk groups based on the 2020 European Crohn's and Colitis Organization and European Society for Pediatric Gastroenterology Hepatology and Nutrition (ECCO-ESPGHAN) guidelines. The primary endpoint was the occurrence of new intestinal complications.
Results:
Among 53 enrolled patients (33 males and 20 females), 8 patients (33.96%) developed intestinal complications during the follow-up period (median 6.42 years, 3.17-9.75 years). Patients in the initial ECCO-ESPGHAN medium- or high-risk group had a 4.71-fold higher risk of intestinal complications than those in the low-risk group [hazard ratio = 4.71, p = 0.023] after adjusting for PCDAI in the multivariate Cox proportional hazard analysis. The other clinical variables did not reach statistical significance in predicting intestinal complications. The positive and negative predictive values of the ECCO-ESPGHAN stratification method for intestinal complications were 48.15% and 80.77%, respectively.
Conclusion:
ECCO-ESPGHAN risk stratification is an effective early predictor of long-term intestinal complications in the Taiwanese population and may be used in clinical practice to guide early advanced therapy.
More Related Videos
10:21Mechanistic Insight into the Development of TNBS-Mediated Intestinal Fibrosis and Evaluating the Inhibitory Effects of Rapamycin
Published on: September 12, 2019
09:50Induction of Intestinal Graft-versus-host Disease and Its Mini-endoscopic Assessment in Live Mice
Published on: February 11, 2019
Related Concept Videos
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:23Renewal of Intestinal Stem Cells
01:23Anatomy of the Intestines
Small Intestines
The small intestine is an ~7 meter-long tube with an inner diameter of just 2.5 cm. Since most nutrients are absorbed here, the inner lining of the...