RT Journal Article
T1 Predicting Outcomes in Pediatric Crohn's Disease for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease-Ahead Program.
A1 Ricciuto, Amanda
A1 Aardoom, Martine
A1 Orlanski-Meyer, Esther
A1 Navon, Dan
A1 Carman, Nicholas
A1 Aloi, Marina
A1 Bronsky, Jiri
A1 Däbritz, Jan
A1 Dubinsky, Marla
A1 Hussey, Séamus
A1 Lewindon, Peter
A1 Martín De Carpi, Javier
A1 Navas-López, Víctor Manuel
A1 Orsi, Marina
A1 Ruemmele, Frank M
A1 Russell, Richard K
A1 Veres, Gabor
A1 Walters, Thomas D
A1 Wilson, David C
A1 Kaiser, Thomas
A1 de Ridder, Lissy
A1 Turner, Dan
A1 Griffiths, Anne M
A1 Pediatric Inflammatory Bowel Disease–Ahead Steering Committee, 
K1 ASCA
K1 Complications
K1 Growth Impairment
K1 NOD2/CARD15
K1 Polymorphism
K1 Prognostic Factors
K1 Serology
K1 Structuring or Penetrating Disease
AB A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.
YR 2020
FD 2020-09-23
LK http://hdl.handle.net/10668/16320
UL http://hdl.handle.net/10668/16320
LA en
DS RISalud
RD Apr 9, 2025