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Long-Term Outcome of Paediatric Crohn's Disease Patients With Deep Ulcerations at Diagnosis
Monica S Ronconi1, Antoine Neuraz2, Elise Payen1
1Service de Gastro-Entérologie et Nutrition Pédiatrique, Centre de Référence Des Maladies Rares Digestives (MARDI), Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Cité, Paris, France.
Insights
Deep ulcerations in pediatric Crohn's disease (CD) patients predict more complications and relapses within the first year. However, this association diminishes over time due to proactive treatment strategies.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Pediatrics
Background:
- Deep ulcerations (DU) at diagnosis are linked to severe Crohn's disease (CD) phenotypes in adults.
- Understanding early indicators of disease severity in pediatric CD is crucial for timely intervention.
Purpose of the Study:
- To determine if DU at diagnosis predicts a more severe disease course in pediatric CD patients.
- To investigate the long-term impact of DU on disease progression and complications in children.
Main Methods:
- Retrospective analysis of 116 pediatric CD patients diagnosed between 2009 and 2017.
- Comparison of disease course, complications, and treatment based on the presence or absence of DU at diagnosis via colonoscopy.
- Data collection included clinical, laboratory, treatment, and complication information at diagnosis and 1, 3, and 5 years post-diagnosis.
Main Results:
- 52 out of 116 pediatric patients had DU at diagnosis.
- Patients with DU showed a significantly higher risk of abdominal abscesses (p=0.045) and relapses (p=0.013) within the first year.
- No significant differences in disease course were observed between groups at 3 and 5 years.
- Pediatric CD patients with DU received anti-TNF alpha therapy sooner after diagnosis.
Conclusions:
- DU at diagnosis is associated with increased complications and relapses in the initial year of pediatric Crohn's disease.
- Aggressive therapeutic management, including earlier anti-TNF alpha initiation, mitigates the long-term impact of DU.
- DU serves as an important early marker for intensified monitoring and treatment in pediatric CD.
Aim:
Presence of deep ulcerations (DU) at diagnosis seems to be predictive of a more severe phenotype in adult Crohn's disease (CD). The aim of our study was to investigate if the presence of DU at diagnosis was associated with a more severe disease course over time in children.
Methods:
In this monocentric retrospective study, we analysed data from paediatric patients with a new diagnosis of CD from 2009 to 2017. Clinical, laboratory data, treatments and complications were recorded for each patient at diagnosis and at 1, 3 and 5 years of follow-up. Patients were compared according to the presence or absence of DU on colonoscopy.
Results:
Among the 116 patients included in the study, 52 patients had DU at diagnosis. Comparison showed an increased risk for patients with DU to develop abdominal abscesses (p = 0.045) and to experience more relapses (p = 0.013) at 1 year. At 3 and 5 years, there was no longer any difference between groups. The time from diagnosis to first anti-TNF alpha was shorter in DU patients.
Conclusion:
The presence of DU at diagnosis is associated with more complications during the first year of follow-up but not after, due to a more active therapeutic management.
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