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Published on: October 29, 2014
Early Surgical Resection in Pediatric Patients with Localized Ileo-Cecal Crohn's Disease: Results of a Retrospective
Isabella Madaffari1, Edoardo Maria Muttillo1, Alice La Franca1
1Department of Medical Surgical Science and Translational Medicine, Sant' Andrea University Hospital, Sapienza University of Rome, 00185 Roma, Italy.
Insights
Early surgery significantly improves localized Crohn's disease (CD) in children. Surgical intervention led to substantial reductions in disease activity scores (SES-CD and PCDAI) and decreased reliance on medical treatments.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease (CD), a type of inflammatory bowel disease (IBD), affects children and often presents in localized areas like the ileocecal region, ileum, or colon.
- Effective management of pediatric CD requires targeted therapies for optimal quality of life and long-term disease control.
- While medical treatments are available, surgical intervention offers benefits for select patients.
Purpose of the Study:
- To evaluate the impact of an early surgical approach on disease activity in pediatric patients with localized Crohn's disease.
- To assess improvements in the Simple Endoscopic Score for Crohn's Disease (SES-CD) and the Pediatric Crohn's Disease Activity Index (PCDAI) post-surgery.
- To determine the efficacy of early surgery in reducing the need for medical interventions such as enteral nutrition and medications.
Main Methods:
- A retrospective multicenter study analyzed data from 29 pediatric patients with localized CD between 2008 and 2023.
- Demographic data, SES-CD, and PCDAI were collected and compared before and after surgical treatment.
- Statistical analysis included Student's t-test for continuous variables and Pearson's Chi-squared or Fisher's exact test for categorical variables.
Main Results:
- Significant reductions were observed in SES-CD (median 12 to 0, p < 0.0001) and PCDAI (median 30 to 0, p < 0.0001), indicating improved disease activity.
- Postoperative outcomes showed a complete cessation of enteral nutrition (51.7% to 0%, p = 0.0001) and antibiotic use (13.8% to 0%, p = 0.0001).
- The proportion of patients requiring two or more medications decreased from 10.3% preoperatively to 0% postoperatively (p = 0.0001).
Conclusions:
- An early surgical approach is a highly effective therapeutic strategy for pediatric patients with localized Crohn's disease.
- Both endoscopic (SES-CD) and clinical (PCDAI) markers demonstrated significant improvement following surgical intervention.
- Early surgery can lead to a decreased need for medical therapies, including nutritional support and pharmacologic treatments.
Abstract:
Background: Crohn's disease (CD) is an inflammatory bowel disease (IBD) that also affects pediatric patients. It frequently presents as a localized disease, affecting the ileocecal area, ileum, or colon. It requires targeted therapy to achieve a good quality of life and long-term control of disease activity. Despite multiple medical therapies available, several patients benefit from surgical treatment. The aim of our study is to demonstrate how an early surgical approach can bring an improvement in disease activity, evaluating the Simple Endoscopic Score for Crohn's Disease (SES-CD) and the Pediatric Crohn's Disease Activity Index (PCDAI). Methods: A retrospective multicenter study was carried out from 2008 to 2023, including 29 patients, affected by localized CD. These data were analyzed: demographics, SES-CD, and PCDAI, before and after surgery. The differences between groups were analyzed using Student's t-test for continuous variables, and Pearson's Chi-squared test or Fisher's exact test for categorical variables. Results: The SES-CD significantly decreased from 12 (median, range 1-15) to 0 (median, range 0-6) (p < 0.0001) and the PCDAI decreased from 30 (median, range 10-50) to 0 (median, range 0-15) (p < 0.0001). The rate of patients receiving enteral nutrition decreased from 51.7% preoperatively to 0% postoperatively (p = 0.0001). The rate of antibiotic use decreased from 13.8% to 0% (p = 0.0001). The rate of patients receiving ≥2 drugs decreased from 10.3% to 0% (p = 0.0001). Conclusions: The early surgical approach can be considered an excellent therapeutic strategy in patients with localized CD. Both parameters examined, SES-CD and PCDAI, demonstrated a clear improvement in the endoscopic images and in disease activity.
