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Perianal Disease Modifiers Are Associated With Less Severe Luminal Disease Activity in Children With Crohn's Disease
Ben Kang1, Jin Soo Moon2, Sujin Choi1
1Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, 41404, Republic of Korea.
Insights
Perianal fistulizing disease in pediatric Crohn's disease (CD) is more frequent in boys and associated with milder initial symptoms. Recognizing this can aid in early diagnosis of underlying luminal CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Crohn's Disease Pathogenesis
Background:
- Limited data exists on the early characteristics of pediatric Crohn's disease (CD) with perianal fistulizing disease.
- Understanding these associations is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the associations between perianal fistulizing disease and other disease characteristics at diagnosis in children with Crohn's disease.
- To identify early clinical clues for underlying luminal CD.
Main Methods:
- A multicenter, registry-based, inception cohort study in Korea.
- Included children newly diagnosed with Crohn's disease (CD).
- Collected baseline demographics, laboratory, endoscopic, histologic data, and Paris classification factors.
Main Results:
- Perianal disease modifiers were present in 50.6% of 699 pediatric CD patients.
- Perianal disease was more common in males and associated with upper GI involvement and B1 behavior.
- Patients with perianal disease had higher albumin and lower CRP levels.
Conclusions:
- Perianal fistulizing disease in pediatric CD is more prevalent in boys with seemingly milder disease activity.
- It serves as a critical clinical indicator for early diagnosis of luminal Crohn's disease.
- Highlights the need for early recognition of perianal manifestations.
Background:
There is lack of data regarding the associations between perianal fistulizing disease and other disease characteristics at diagnosis in children with Crohn's disease (CD). We sought to investigate the associations between perianal fistulizing disease and other disease characteristics at diagnosis in children with CD.
Methods:
This was a multicenter, registry-based, inception cohort study conducted in Korea. Children newly diagnosed with CD were included. Baseline clinicodemographics; results from laboratory, endoscopic, histologic exams; and Paris classification factors were collected, and associations between factors were investigated.
Results:
A total 699 patients were included. The median age at diagnosis was 14.3 years (IQR, 12.3-15.9 years), and the male-to-female ratio was 2.66:1. Perianal disease modifiers comprised 50.6% (n = 354 of 699) of the patients. The proportion of perianal disease modifiers was higher in males (81.1% vs 64.1%; P < .001), in those with upper gastrointestinal tract involvement (85.3% vs 75.7%; P = .002), and in those with B1 behavior (89.5% vs 79.7%; P < .001). Albumin was higher (P = .006) and CRP was lower (P < .001) in patients with perianal disease modifiers. Females had a higher proportion of B2/B3 behavior (21.4% vs 14.4%; P = .029), higher Pediatric Crohn's Disease Activity Index scores (median 40 vs 32.5; P < .001), higher CRP (P = .017), higher Simple Endoscopic Score for Crohn's Disease scores (P = .01), and more frequent detection of noncaseating granulomas in the lower gastrointestinal tract (P = .008).
Conclusions:
Perianal fistulizing disease was more common in boys who exhibited milder disease activity, indicating the importance of recognizing perianal fistulizing disease as a clinical clue to the early diagnosis of underlying luminal CD.
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