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.
Article first published online 9 May 2012
*Univ Lille Nord de France, CHU Lille and Lille-2 University, Gastroenterology Unit, France
†Univ Lille Nord de France, CHU Lille and Lille-2 University, Biostatistics Unit EA 2694, France
‡Univ Lille Nord de France, CHU Lille and Lille-2 University Pediatric Unit, France
§Gastroenterology Unit, Amiens University and Hospital, France
‖Gastroenterology Unit, Rouen University and Hospital, France
¶Epidemiology Unit, Rouen University and Hospital, France
**Gastroenterology Unit, INSERM U954, Nancy University and Hospital, France
††Univ Lille Nord de France, CHU Lille and Lille-2 University Epidemiology Unit, France.
Reprints: Dr. Corinne Gower-Rousseau, Registre EPIMAD, Service Régional d'Epidémiologie, Parc EURASANTE, 154 rue du Dr Yersin, CHRU Lille, 59037 Lille cedex, France (e-mail: Corinne.firstname.lastname@example.org).
Financial support: EPIMAD is organized under an agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM) and the Institut de Veille Sanitaire (InVS) and also received financial support from the François Aupetit Association, the Lion's Club of Northwestern France, Ferring Laboratories, the Société Nationale Française de Gastroentérologie, Lille University Hospital, and GIS-Maladies Rares (INSERM 2003).
Presented in part at the American Gastroenterology Association meeting held in Chicago, 2011.
Received April 05, 2012
Accepted April 07, 2012