Gastroenterology

Gastroenterology

Volume 135, Issue 4, October 2008, Pages 1106-1113
Gastroenterology

Clinical—Alimentary Tract
Natural History of Pediatric Crohn's Disease: A Population-Based Cohort Study

https://doi.org/10.1053/j.gastro.2008.06.079Get rights and content

Background & Aims: The natural history of pediatric Crohn's disease and risk factors necessitating surgery have not been thoroughly described. Methods: In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 404 Crohn's disease patients (ages, 0–17 years at diagnosis) with a follow-up time ≥2 years. Results: Median follow-up time was 84 months (range, 52–124 months). The most frequent disease location at diagnosis was the terminal ileum/colon (63%). Follow-up was characterized by disease extension in 31% of children. Complicated behavior was observed in 29% of children at diagnosis and 59% at follow-up. Kaplan–Meier survival estimates of the cumulative incidence of surgery were 20% at 3 years and 34% at 5 years from diagnosis. Multivariate Cox models showed that both structuring behavior at diagnosis (hazard ratio [HR], 2.54; 95% confidence interval [CI]: 1.58–4.01) and treatment with corticosteroids (HR, 2.98; 95% CI: 1.64–5.41) were associated with increased risk for surgery, whereas treatment with azathioprine (HR, 0.51; 95% CI: 0.33–0.78) was associated with decreased risk. Azathioprine was introduced earlier in the course of disease in patients not undergoing surgery than in patients requiring surgery. Conclusions: Pediatric Crohn's disease was characterized by frequent occurrence, with time, of a severe phenotype with extensive, complicated disease. Immunosuppressive therapy may improve the natural history of this disease and decrease the need for performing surgery.

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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  • Cited by (0)

    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.

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