Natural history of pediatric Crohn's disease: a population-based cohort study.

Authors: Vernier-Massouille G,Balde M,Salleron J,Turck D,Dupas JL,Mouterde O,Merle V,Salomez JL,Branche J,Marti R,Lerebours E,Cortot A,Gower-Rousseau C,Colombel JF,
Address: Registre des Maladies inflammatoires chroniques de l'Intestin du Nord Ouest de la France EPIMAD, Service d'Hépato-Gastroentérologie, Hôpital Claude Huriez, Lille, France.
Journal: Gastroenterology.

Publication: 2008 Oct;135(4):1106-13. doi: 10.1053/j.gastro.2008.06.079. Epub 2008 Jul 3.

abstract

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 >or=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.

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