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Incidence and characteristics of pediatric patients with Crohn's disease undergoing surgery: A cross-sectional study
Hugo Gagnon1, Marie-Frédérique Paré1, Guillermo Costaguta1
1Centre Hospitalier Universitaire Sainte-Justine, Division of Gastroenterology, Hepatology and Nutrition Montréal Quebec Canada.
Insights
Pediatric Crohn's disease (CD) surgery rates significantly decreased after 2019, likely due to earlier biologic treatment initiation. This improvement highlights advancements in managing pediatric inflammatory bowel disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Outcomes in Children
Background:
- Biological treatments have reduced the burden of pediatric inflammatory bowel disease (IBD).
- However, many pediatric IBD patients still require surgery.
- Data on pediatric IBD patient characteristics and surgical incidence are limited and often extrapolated from adult studies.
Purpose of the Study:
- To assess the characteristics of pediatric Crohn's disease (CD) at diagnosis.
- To compare surgery rates in pediatric CD patients before and after 2019.
- To identify patient characteristics associated with surgical intervention in pediatric CD.
Main Methods:
- Retrospective analysis of pediatric CD patients undergoing surgery at CHU Sainte-Justine from 2014-2023.
- Descriptive statistics and Mann-Whitney U-test for comparing means.
- Kaplan-Meier curves to assess surgery-free survival (p < 0.05).
Main Results:
- Overall surgery incidence was 5.2/1000 person-years.
- Surgery rates were significantly lower after 2019 (5.6/1000) compared to before 2019 (14.7/1000).
- Earlier biologic initiation (median 14 days post-2019 vs. 142 days pre-2019) correlated with reduced surgery rates (p=0.01).
Conclusions:
- A significant reduction in pediatric CD surgery incidence has been observed since 2019.
- This improvement is likely attributed to earlier initiation of biologic therapies.
- Increased use of infliximab, proactive drug monitoring, and enhanced nonresponder management contribute to better outcomes.
Objectives:
Despite biological treatments reducing the burden of pediatric inflammatory bowel disease, many patients still require surgery. Data on pediatric patient characteristics and surgical incidence are limited, often based on adult studies. This study aimed to assess the characteristics of pediatric Crohn's disease (CD) at diagnosis and compare surgery rates between two periods (before and after 2019) to understand which patients require surgery.
Methods:
We analyzed pediatric CD patients who underwent surgery at CHU Sainte-Justine, Montreal, between 2014 and 2023. Descriptive statistics and the Mann-Whitney U-test were used to compare means, while Kaplan-Meier curves assessed surgery-free survival, with significance set at p < 0.05.
Results:
The overall surgery incidence was 5.2/1000 person-years. Surgery rates were lower for patients diagnosed after 2019 than before 2019 (5.6/1000 vs. 14.7/1000 person-years). There were no significant differences in age at diagnosis, CD Paris score, reason for surgery, or disease severity. Among CD patients, surgeries were more frequent before 2019 (11.5% vs. 2.8%, p < 0.001). The reduction in surgery rates since 2019 is likely due to earlier initiation of biologics, with a median initiation of 14 days after 2019 compared to 142 days before 2019 (p = 0.01).
Conclusion:
The reduced incidence of surgery in pediatric CD is a significant achievement. Increased use of infliximab, proactive drug monitoring, and better nonresponder management likely contribute to this improvement.
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