Journal
INFLAMMATORY BOWEL DISEASES
Volume 16, Issue 4, Pages 638-644Publisher
OXFORD UNIV PRESS INC
DOI: 10.1002/ibd.21099
Keywords
abscess; fistula; non-inflammatory disease; complicated disease; children; adolescence; outcomes; database; registry; inflammatory bowel disease
Categories
Funding
- National Institutes of Health (NIH) [DK060617, DK53708, DK006544, DK007762, DK077734]
- Children's Digestive Health and Nutrition Foundation/Crohn's and Colitis Foundation of America (CCFA)
- CCFA Career Development Award
- NIH/NCRR UCSF-CTSI [UL1 RR024131]
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Background: The development of disease complications is poorly characterized in pediatric patients with Crohn's disease (CD). Methods: We retrospectively determined the cumulative incidence of stricturing and penetrating complications of CD prior to first surgery utilizing data from 989 consecutively enrolled CD patients (age (0-17 years at diagnosis) collected between January 2000 and November 2003 and stored in the Pediatric IBD Consortium Registry. Results: Mean age at diagnosis was 11.5 +/- 3.8 (standard deviation) years. Median follow-up time was 2.8 years. Prior to first surgery, the cumulative incidence of stricturing or penetrating complications was 27% at 5 years and 38% at 10 years from the diagnosis of inflammatory bowel disease. The cumulative incidence of complicated disease was lowest in isolated colonic disease (P = 0.009). Penetrating complications that followed stricturing complications prior to first surgery occurred within 2 years of stricturing complications (cumulative incidence was 13% at 2 years from diagnosis of stricturing disease). Stricturing complications that followed penetrating complications prior to first surgery occurred within 8 years of penetrating complications (cumulative incidence was 26% at 8 years from diagnosis of penetrating complications). Conclusions: Strictures, abscesses, and fistulas are common in pediatric CD. Earlier aggressive management may be indicated. Prospective study is required to identify genetic and serologic markers that predict a patient's risk for the development of complicated disease and to determine optimal treatment regimens.
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