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Risk of Crohn's disease in children presenting with perianal abscess and fistula increases with age: A multicenter
Mariëlle Roskam1, Thomas Dierikx2, Sanne Hulsmann2
1Department of Pediatrics, Emma Children's Hospital, Amsterdam Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
Insights
Children with perianal abscesses (PA) and fistulas-in-ano (FIA) have a 21% risk of developing Crohn's disease (CD), with higher risk in older children. Physicians should maintain high awareness for CD development in these patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Pediatrics
Background:
- Perianal abscesses (PA) and fistulas-in-ano (FIA) are common in children.
- These conditions may indicate underlying Crohn's disease (CD).
- The relationship between age at PA/FIA presentation and subsequent CD risk is not well understood.
Purpose of the Study:
- To investigate the association between PA/FIA and the risk of developing CD.
- To stratify this risk based on the age of the child at presentation.
Main Methods:
- Retrospective, multicenter study of children aged 2-18 years with PA/FIA.
- Data collected included patient characteristics, biochemical markers, and CD development.
- Risk stratification by age into three subgroups: <6, 6-12, and 12-18 years.
Main Results:
- 32 out of 152 children (21.1%) with PA/FIA were diagnosed with CD.
- Children aged 12-18 years had a significantly higher CD diagnosis rate (32.4%) compared to younger groups.
- Recurrent PA/FIA, IBD-associated symptoms, and elevated fecal calprotectin were strongly associated with CD development.
Conclusions:
- The overall risk of CD in children with PA/FIA is 21% and is age-dependent.
- Physicians need heightened awareness for CD in children presenting with PA/FIA, especially those aged 6 years and older.
- Monitoring for CD is crucial, even in the years following the initial PA/FIA presentation.
Objectives:
Perianal abscesses (PA) and fistulas-in-ano (FIA) are frequently diagnosed in children and may be presenting symptoms of Crohn's disease (CD). The association between age at presentation of PA/FIA and the risk of subsequent CD development is largely unknown. Aim of this study was to investigate the association between PA/FIA and risk for CD development, stratified by age.
Methods:
In this retrospective multicenter study children between 2 and 18 years presenting with PA/FIA, were included. Patient characteristics, biochemical data, and data on CD development were collected. The risk of developing IBD was stratified by age in three subgroups (<6, 6-12, and 12-18 years).
Results:
One hundred and fifty-two children with PA/FIA were included (78% male; median age 11.1 years; interquartile range [IQR]: 8.0), of whom 32 (21.1%) were diagnosed with CD. Children aged 12-18 years (n = 23; 32.4%) were more often diagnosed with CD compared to the subgroup 6-12 years (n = 8; 15.1%) odds ratio (OR) 2.09; p = 0.03) and the subgroup 2-6 years (n = 1; 3.6%; OR 14.24; p = 0.01). Recurrent PA/FIA (OR 3.20; p = 0.005) and typical inflammatory bowel disease (IBD)-associated symptoms (OR 4.85; p < 0.001) were significantly associated with CD development. Median value of elevated fecal calprotectin (FCP) was significantly higher in the CD group (1212 µg/g) than in the non-CD group (22.5 µg/g; p < 0.001).
Conclusions:
The overall risk of developing CD in children presenting with PA/FIA was 21%, this risk was age dependent. Our findings emphasize the need for high awareness by physicians in children presenting with PA/FIA for the development of CD, also in the years following first presentation, particularly when aged ≥6 years.
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