Clinical—Alimentary TractNatural History of Pediatric Crohn's Disease: A Population-Based Cohort Study
Section snippets
Patient Population
Cases included all patients in the EPIMAD registry diagnosed with CD between January 1988 and December 2002, under 17 years of age at time of diagnosis. Study area was northern France, with 5,790,526 inhabitants (1999 national population census) divided into 4 regions: Nord, Pas-de-Calais, Somme, and Seine-Maritime. The population under 17 years of age was as follows: Nord: 593,837; Pas de Calais: 332,228 (2 regions henceforth referred to as “Nord-Pas de Calais”); Somme: 115,969;
Demographic Information
From 1988 to 2002, 9114 patients were diagnosed with IBD, 649 (7%) of whom were less than 17 years old: CD (n = 472) (73% of all pediatric cases), UC (n = 151) (23%), and indeterminate colitis (n = 26) (4%). The pediatric CD mean annual incidence standardized on age and sex4 was 2.6/105 (95% confidence interval [CI]: 2.4–2.8). Among patients with CD, 256 were males and 216 females (sex ratio M/F, 1.18). Median age at diagnosis was 14 years (range, 11–16 years). Twenty-five patients were lost to
Discussion
This is the largest population-based study of pediatric CD reported to date. Childhood-onset CD is characterized by widespread extent, frequent evolution of disease behavior toward more complicated forms, a high prevalence of extraintestinal manifestations, and complications and early prescription of corticosteroids, leading to dependence in one fourth of patients at 1 year and need for surgical resection in more than half of patients despite increasing use of immunomodulators.
One major
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EPIMAD is organized under an agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM) and the Institut National de Veille Sanitaire (InVS) and is also supported by the François Aupetit Association, Lion's Club of Northwestern France, Ferring Laboratories, the Société Nationale Française de Gastroentérologie, and Lille University Hospital.
Financial disclosure: The EPIMAD Registry is partly funded by the Ferring Company.