Skip Navigation LinksHome > January 2013 - Volume 19 - Issue 1 > Long-term Outcome After First Intestinal Resection in Pediat...
Inflammatory Bowel Diseases:
doi: 10.1002/ibd.23004
Original Clinical Articles

Long-term Outcome After First Intestinal Resection in Pediatric-onset Crohn's Disease: A Population-based Study

Boualit, Médina MD*; Salleron, Julia MS; Turck, Dominique MD; Fumery, Mathurin MD§; Savoye, Guillaume MD, PhD; Dupas, Jean-Louis MD, PhD§; Lerebours, Eric MD, PhD; Duhamel, Alain MD, PhD; Merle, Véronique MD, PhD; Cortot, Antoine MD, PhD*; Colombel, Jean-Frédéric MD*; Peyrin-Biroulet, Laurent MD, PhD**; Gower-Rousseau, Corinne MD†,††; the EPIMAD group

Collapse Box

Abstract

Background: To describe long-term postoperative evolution of pediatric-onset Crohn's disease (CD) and identify predictors of outcome we studied a population-based cohort (1988–2004) of 404 patients (0–17 years), of which 130 underwent surgery.

Methods: Risks for a second resection and first need for immunosuppressors (IS) and/or biologics were estimated by survival analysis and Cox models used to determine predictors of outcome. Impact of time of first surgery on nutritional catch-up was studied using regression.

Results: In all, 130 patients (70 females) with a median age at diagnosis of 14.2 years (interquartile range: 12–16) were followed for 13 years (9.4–16.6). Probability of a second resection was 8%, 17%, and 29% at 2, 5, and 10 years, respectively. In multivariate analysis, age <14, stenosing (B2) and penetrating (B3) behaviors and upper gastrointestinal location (L4) at diagnosis were associated with an increased risk of second resection. Probability of receiving IS or biologics was 18%, 34%, and 47% at 2, 5, and 10 years, respectively. In multivariate analysis, L4 was a risk factor for requiring IS or biologics, while surgery within 3 years after CD diagnosis was protective. Catch-up in height and weight was better in patients who underwent surgery within 3 years after CD diagnosis than those operated on later.

Conclusions: In this pediatric-onset CD study, mostly performed in a prebiologic era, a first surgery performed within 3 years after CD diagnosis was associated with a reduced need for IS and biologics and a better catch-up in height and weight compared to later surgery.

© Crohn's & Colitis Foundation of America, Inc.

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.