Characteristics Associated With Early Ileocolonic Resection in Pediatric Crohn's Disease

Area of Science:

• Pediatric Gastroenterology
• Surgical Gastroenterology
• Inflammatory Bowel Disease Research

Background:

• Pediatric-onset Crohn's disease (CD) exhibits a more severe phenotype compared to adult-onset CD.
• Approximately one-third of pediatric CD patients necessitate surgical intervention.
• Limited data exists on patient and disease characteristics associated with earlier surgical management in pediatric CD.

Purpose of the Study:

• To identify patient and disease characteristics linked to earlier surgical management in pediatric Crohn's disease.
• To understand the implications of early surgical intervention on treatment patterns and disease course.

Main Methods:

• Retrospective review of pediatric CD patients (<22 years) who underwent ileocolectomy between 2005 and 2021.
• Unadjusted statistical analyses including Pearson chi-squared tests, t-tests, and analysis of variance were employed.

Main Results:

• 135 pediatric CD patients underwent ileocolectomy, with a median time to surgery of 3.75 years.
• Patients undergoing early surgery (<3.75 years) were older at diagnosis but younger at surgery, received fewer CD medications, and had less exposure to multiple biologics.
• Abscess formation was a more frequent indication for early surgery, while failure to thrive/refractory pain was more common for later surgery.

Conclusions:

• Surgical therapy is a critical aspect of pediatric CD management.
• Earlier surgical management in pediatric CD is associated with earlier biologic use, shorter intervals between biologic initiation and surgery, and fewer overall medications.
• These findings suggest that earlier surgery may indicate a more severe, refractory disease phenotype in pediatric Crohn's disease.