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Published on: October 29, 2014
Characteristics and long-term outcomes of children with perianal Crohn's disease
Ching-Chun Lin1,2, Ichiro Takeuchi3, Hirotaka Shimizu3
1Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Pediatric Crohn's disease (CD) patients with perianal lesions (PL) require prompt treatment. Early biologic and surgical interventions in children with CD and PL can reduce corticosteroid use and ostomy necessity.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Gastroenterology
Background:
- Perianal lesions (PL) are more common in East Asian pediatric Crohn's disease (CD) patients.
- Early intervention for PL is crucial to prevent long-term complications like sphincter dysfunction and ostomy.
- Understanding the clinical course of pediatric CD with PL is vital for effective management.
Purpose of the Study:
- To investigate the clinical features of pediatric CD patients with PL.
- To analyze treatment strategies and outcomes for pediatric CD with PL.
- To identify risk factors and consequences associated with PL in pediatric CD.
Main Methods:
- Retrospective cohort study of pediatric CD patients diagnosed between 2010 and 2020.
- Evaluation of demographics, treatments (including biologics and setons), and outcomes (ostomy placement).
- Comparison of outcomes between very early-onset (VEO) CD and older pediatric CD patients with PL.
Main Results:
- 32.1% of 112 pediatric CD patients experienced PL.
- VEO-CD patients with PL had a significantly higher rate of ostomy placement (42.9% vs. 0.0%).
- Biologic therapy (infliximab, adalimumab, ustekinumab, etc.) was utilized in 94.4% of patients, with earlier introduction in recent years (2016-2020).
Conclusions:
- Very early-onset CD patients with perianal lesions face a high risk of requiring ostomy.
- Timely introduction of biologics and surgical interventions can decrease corticosteroid dependency and ostomy rates.
- Aggressive management strategies are essential for improving outcomes in pediatric CD with PL.
Background/Aims:
The incidence of perianal lesions (PL) in children with Crohn's disease (CD) is higher in East Asia than in Western countries. Early intervention for PL is essential to prevent sphincter dysfunction and ostomy placement. In this study, we aimed to investigate the clinical features, treatment, and consequences of pediatric CD with PL.
Methods:
We retrospectively reviewed a cohort of children diagnosed with CD from 2010 to 2020 at a Japanese children's hospital. Demographics, treatments, and outcomes were evaluated and compared among subgroups.
Results:
Among 112 pediatric patients with CD, 36 (32.1%) had experienced PL during the observational period. The median ages at diagnosis and follow-up periods were 131 and 70 months, respectively. Six (85.7%) patients in the very early-onset (VEO) group (CD diagnosed before 6 years old) and 24 (82.8%) in the older age group had PL upon diagnosis of CD (P= 0.851). Biologics were given to 94.4% of patients: infliximab (67.7%), adalimumab (58.8%), ustekinumab (44.1%), risankizumab (11.8%), and vedolizumab (5.9%). Biologics were introduced within 1 year in 89.5% and 40.0% of patients diagnosed in 2016-2020 and 2010-2016, respectively (P= 0.002). Seton was frequently used in the older age group (87.5 vs. 42.9%, P= 0.190). Ostomy was frequently required in the VEO group (42.9% vs. 0.0%, P= 0.006).
Conclusions:
Patients with VEO-CD and PL had a notably high risk of ostomy placement. The earlier introduction of biologics and surgical interventions reduced corticosteroids use and ostomy placement in pediatric CD patients with PL.
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