Clinical predictors at diagnosis of disabling pediatric Crohn's disease

Gastroenterology Unit, EPIMAD Registry, Rouen University and Hospital, France.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 11/2012; 18(11):2072-8. DOI: 10.1002/ibd.22898
Source: PubMed


Identification of children with Crohn's disease (CD) at high risk of disabling disease would be invaluable in guiding initial therapy. Our study aimed to identify predictors at diagnosis of a subsequent disabling course in a population-based cohort of patients with pediatric-onset CD.
Among 537 patients with pediatric CD diagnosed at <17 years of age, 309 (57%) with 5-year follow-up were included. Clinical and demographic factors associated with subsequent disabling CD were studied. Three definitions of disabling CD were used: Saint-Antoine and Liège Hospitals' definitions and a new pediatric definition based on the presence at maximal follow-up of: 1) growth delay defined by body mass index (BMI), weight or height lower than -2 SD Z score; and 2) at least one intestinal resection or two anal interventions. Predictors were determined using multivariate analyses and their accuracy using the kappa method considering a relevant value ≥0.6.
According to the Saint-Antoine definition, the rate of disabling CD was 77% and predictors were complicated behavior and L1 location. According to the Liège definition, the rate was 37% and predictors included behavior, upper gastrointestinal disease, and extraintestinal manifestations. According to the pediatric definition, the rate of disabling CD was 15%, and predictors included complicated behavior, age <14, and growth delay at diagnosis. Kappa values for each combination of predictors were, respectively, 0.2, 0.3, and 0.2 and were nonrelevant.
Clinical parameters at diagnosis are insufficient to predict a disabling course of pediatric CD. More complex models including serological and genetic biomarkers should be tested. (Inflamm Bowel Dis 2012;).

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Available from: Mathurin Fumery, Oct 16, 2014
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    • "In this studt, most children with CD showed poor weight gain, as defined by lower BMI at the time of initial diagnosis of IBD. A recent study also documented that BMI is one of the clinical predictors of a subsequently disabling course of CD in children [19]. "
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    ABSTRACT: The clinical presentations of inflammatory bowel disease (IBD) prior to diagnosis are so diverse or vague that many of them waste time before final diagnosis. This study was undertaken to know the medical history of the pediatric patients until the final diagnosis could be reached. The medical records of all pediatric patients who were diagnosed with IBD (Crohn's disease [CD] in 14 children, ulcerative colitis [UC] in 17) during the last 13 years were reviewed. We investigated the length of the diagnostic time lag, chief clinical presentation, and any useful laboratory predictor among the routinely performed examinations. Indeterminate colitis was not included. The mean ages of children at the final diagnosis was similar in both diseases. As for the pre-clinical past history of bowel symptoms in CD patients, 5 were previously healthy, 9 had had 1-3 gastrointestinal (GI) symptoms, weight loss, bloody stool, anemia and rectal prolapse. With UC, 9 were previously healthy, 8 had had 1-3 GI symptoms, bloody stool, anorexia. The average diagnostic time lag with CD was 3.36 months, and with UC 2.2 months. Body mass index (BMI) and the initial basic laboratory data (white blood cell, hemoglobin, mean corpuscular volume, serum albumin, and serum total protein) were lower in CD, statistically significant only in BMI. IBD shows diverse clinical symptoms before its classical features, making the patients waste time until diagnosis. It is important to concern possibility of IBD even in the mildly sick children who do not show the characteristic symptoms of IBD.
    09/2013; 16(3):178-84. DOI:10.5223/pghn.2013.16.3.178
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    • "In this single centre study we have described a well-defined cohort of paediatric patients with stricturing CD, 36% of which exhibited a stricturing phenotype at the diagnosis of CD. Available data on behaviour and course of paediatric CD suggest that the majority of patients develop a complicated course during the follow-up [6] [7] [25], with an inflammatory (non-stricturing and non-penetrating) pattern as the most common phenotype at the Table 3 Univariate analysis between complete and partial responders and non-responders to medical therapy at the end of the follow-up. "
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    ABSTRACT: BACKGROUND: Stricturing is the most common complicated phenotype in paediatric Crohn's disease, but only few studies have described its course, while data on the outcome of medical treatment are scanty. AIM: To retrospectively describes the course of paediatric stricturing Crohn's disease and assess clinical and imaging response to medical therapy. PATIENTS AND METHODS: Thirty-six patients with stricturing Crohn's disease were identified by our department database. Paediatric Crohn's disease activity index, need of surgery and magnetic resonance were evaluated as outcomes at 6, 12, 18 and 24 months after detection of stenosis. RESULTS: Strictures were ileal, ileocolonic and colonic in 61%, 28% and 11% of patients. Thirteen (36%) had stricturing disease at the diagnosis of Crohn's disease, while 64% developed it at the follow-up. At baseline, 89% had medical treatment, while 11% surgery. At 6, 12, 18, and 24 months, 53%, 50%, 42%, and 35% had complete response to medical treatment, respectively. Overall, 44% were unresponsive to medical therapy and required surgery at the follow-up. Responders and non-responders significantly differed for inflammatory imaging findings at the stenosis detection. CONCLUSIONS: A stricturing phenotype is not uncommon at the diagnosis of Crohn's disease in children. Medical therapy seems poorly effective in avoiding intestinal resection. Magnetic resonance imaging is valuable in identifying patients who will benefit from medical therapy.
    Digestive and Liver Disease 03/2013; 45(6). DOI:10.1016/j.dld.2013.01.020 · 2.96 Impact Factor
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    • "These differences occur despite the much more frequent resort to immunosuppressants and biologic therapy in children than in the elderly: 61% vs. 23% and 24% vs. 7% respectively. Finally, a disappointing observation from the registry was the difficulty in predicting the " disabling " course of IBD based on demographic and clinical characteristics on diagnosis [37]. Furthermore , even though surgery is generally considered as disabling, a first intestinal resection performed within 3 years after diagnosis of CD in children was associated with reduced need for further Fig. 3. Comparison of CD location on diagnosis between elderly onset patients (n = 367) and paediatric-onset patients (n = 689). "
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    ABSTRACT: Most data regarding the natural history of inflammatory bowel diseases and their therapeutic management are from tertiary referral-centres. However, the patients followed in these centres represent a selected sample and extrapolation of these data to the general population is disputable. The EPIMAD Registry covers a large area of Northern France with almost 6 million inhabitants representing 9.3% of the entire French population. From 1988 to 2008, 18,170 incident patients were recorded in the registry including 8071 incident Crohn's disease, 5113 incident ulcerative colitis and 591 unclassified inflammatory bowel disease cases. The aim of this study was to review some of the most recent information obtained from this large population-based registry since its launch in 1988.
    Digestive and Liver Disease 10/2012; 45(2). DOI:10.1016/j.dld.2012.09.005 · 2.96 Impact Factor
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