Original article—alimentary tractIncreased Immune Reactivity Predicts Aggressive Complicating Crohn's Disease in Children
Section snippets
Patient Population
Pediatric CD patients were enrolled from 21 participating sites of the Western Regional Pediatric IBD Research Alliance, the Pediatric IBD Collaborative Research Group, and the Wisconsin Pediatric IBD Alliance.6, 8, 9
To be eligible, all CD patients must have undergone complete colonoscopy with ileal intubation or complete colonoscopy and small-bowel follow-through. A diagnosis of CD for this study was based on standard diagnostic criteria.10 Blood was drawn at each of the participating sites
Patient Demographics
A total of 796 pediatric CD patients were eligible for analysis. The median age at diagnosis was 12 years (0.6–18 years), and the median disease duration as of last follow-up was 32 months (1–235 months). The cohort was composed of 56% male and 44% female patients, and 87% were white, and 28% were of Jewish background.
Clinical Phenotypes
A total of 236 (30.3%) patients presented with (96/796 [12%]) or developed (140/796 [18%]) at least 1 disease complication within the median follow-up time of 32 months (Table 1).
Discussion
Longitudinal analysis in our large pediatric multicenter cohort demonstrated that disease progression from uncomplicated to IP/S phenotypes and CD-related surgery is accelerated in the presence of antimicrobial immune reactivity. Both the number of immune responses and the magnitude of immune response to various microbial antigens were predictive of aggressive disease phenotypes on the basis of the results from the subgroup of patients who had serologies drawn before a complication occurred and
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Cited by (0)
Supported by National Institute of Health K23 DK066248 (M.D.), K23 RR016111 (S.K.), IBD Program Project Grant DK 46763 (S.R.T., J.I.R., K.D.T.), The Cedars-Sinai Board of Governors' Chair in Medical Genetics (J.I.R.), and General Clinical Research Center, Grant #MO1-RR00425 (K.D.T.).