Publication:
Perianal Pediatric Crohn Disease Is Associated With a Distinct Phenotype and Greater Inflammatory Burden.

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Date

2017-09-01

Authors

Assa, Amit
Amitai, Michal
Greer, Mary-Louise
Castro, Denise A
Kuint, Ruth C
Martinez-Leon, Maria
Herman-Sucharska, Izabela
Coppenrath, Eva
Anupindi, Sudha
Towbin, Alexander

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Wiley
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Abstract

Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults. Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months. Of the 234 included patients (mean age 14.2 ± 2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ± 0.7 vs 4.5 ± 0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings. Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.

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MeSH Terms

Adolescent
Anal Canal
Child
Child, Preschool
Crohn Disease
Cross-Sectional Studies
Databases, Factual
Female
Humans
Logistic Models
Longitudinal Studies
Male

DeCS Terms

Espectroscopía de Resonancia Magnética
Albúmina sérica
Granuloma
Enfermedad de Crohn

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Keywords

Phenotype, Prognosis, Rectal Fistula, Severity of Illness Index, Children, Penetrating, Stricturing

Citation

Assa A, Amitai M, Greer ML, Castro DA, Kuint RC, Martínez-León M, et al. Perianal Pediatric Crohn Disease Is Associated With a Distinct Phenotype and Greater Inflammatory Burden. J Pediatr Gastroenterol Nutr. 2017 Sep;65(3):293-298