Related Experiment Video
Updated: Sep 18, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Long-Term Outcome of Colonic and Ileal Crohn's Disease: A Two-Decade Population-Based Study in Pediatric-Onset
Mathurin Fumery1, Guillaume Savoye2, Hélène Sarter3,4
1Gastroenterology Unit, Amiens University Hospital, and PeriTox, Université de Picardie Jules Verne, Amiens, France.
Insights
Pediatric Crohn's disease (CD) location impacts presentation and outcomes. Colonic CD (CD-L2) shows higher risks of perianal disease and extraintestinal manifestations compared to ileal CD (CD-L1).
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Clinical Epidemiology
Background:
- Disease location in Crohn's disease (CD) influences complication risks and treatment strategies.
- Understanding differences between ileal CD (CD-L1), colonic CD (CD-L2), and ulcerative colitis (UC) in pediatric IBD is crucial.
Purpose of the Study:
- To compare the clinical presentation at diagnosis and natural history of colonic CD versus ileal CD and UC in pediatric-onset IBD.
- To identify distinct characteristics and outcomes based on disease location.
Main Methods:
- A population-based registry study included children (<17 years) diagnosed with CD or UC between 1988 and 2011.
- Compared presentation, complication risks, surgery, hospitalization, and treatment exposure for ileal CD (CD-L1), colonic CD (CD-L2), and UC.
Main Results:
- Incidence rates varied: UC (1.02), CD-L2 (0.71), CD-L1 (0.65) per 10^5 persons.
- Colonic CD (CD-L2) showed more bloody stools (44%), higher granuloma presence (31%), increased risk of L3 extension (37% vs. 14%), and higher rates of anoperianal lesions (HR 2.1) and extraintestinal manifestations.
- Ileal CD (CD-L1) had a higher 5-year surgery risk (37%), while CD-L2 showed increased exposure to corticosteroids (69%), immunosuppressants (61%), and anti-TNF agents (35%).
Conclusions:
- Significant differences exist in the clinical presentation and evolution of ileal and colonic CD in children.
- Colonic CD location is linked to a higher risk of perianal disease, extraintestinal manifestations, and increased need for steroids, immunosuppressants, and anti-TNF therapies.
- These location-specific differences suggest the need for tailored therapeutic approaches in pediatric IBD management.
Introduction:
Crohn's disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset inflammatory bowel disease (IBD).
Patients And Methods:
All children (<17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were included. The presentation at diagnosis, the risks of complications, surgery, hospitalization, and exposure to different treatments in ileal CD (CD-L1), colonic CD (CD-L2), and UC were compared.
Results:
A total of 215 CD-L1 patients, 234 CD-L2 patients, and 337 UC patients were included. Over the study period, the annual incidence rates of CD-L1, CD-L2, and UC were 0.65 (95% CI, 0.57-0.74), 0.71 (0.62-0.81), and 1.02 (0.92-1.14) per 105 persons, respectively. At diagnosis, the proportion of males (L1 53%; L2 53%; UC 43%; P = .012), age at diagnosis (15.0; 13.7; 14.0 years; P = .003), family history of IBD (13%; 11%; 5%; P = .005), diagnostic delay (3.0; 3.0; 2.0 months; P = .001), and smoking prevalence (12%; 8%; 6%; P = .041) were different between the 3 groups. Bloody stools at diagnosis were observed in 15%, 44%, and 91% for, respectively, CD-L1, CD-L2, and UC (P < .001), and diarrhea in 47%, 72%, and 65% (P < .001). At diagnosis, the presence of granuloma was identified in 13% of CD-L1 patients and 31% of CD-L2 patients (P < .001). The risk of extension to L3 was significantly higher in the CD-L2 group than in the CD-L1 group (at 5 years-37% vs. 14%, P < .001). L2 location was associated with a lower risk of luminal fistula (hazard ratio [HR] 0.4 [0.2-0.6], P < .001) but was associated with a higher risk of anoperianal lesion (HR 2.1 [1.3-3.4], P = .003). The prevalence of extraintestinal manifestations, articular (P < .001) and cutaneous (P < .001), was higher in CD-L2. While the 5-year risk of surgery was significantly higher in case of CD-L1 (37%, 13%, and 13%; P < .001), the 5-year exposure to corticosteroids (55%, 69%, and 67%; P < .001), immunosuppressants (47%, 61%, and 42%; p < .001), and anti-TNF (16%, 35%, and 21%; P < .001) were higher in case of L2 location.
Conclusions:
The clinical presentation and evolution of ileal and colonic CD differ significantly in children. Colonic location is associated with a high risk of perianal CD, extraintestinal manifestations, and exposure to steroids, immunosuppressants, and anti-TNFs. These differences could justify different therapeutic approaches.
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...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
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...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
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...