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The natural history of Crohn’s disease in children: a review of population-based studies

Duricova, Dana; Fumery, Mathurin; Annese, Vito; Lakatos, Peter L.; Peyrin-Biroulet, Laurent; Gower-Rousseau, Corinne

European Journal of Gastroenterology & Hepatology: February 2017 - Volume 29 - Issue 2 - p 125–134
doi: 10.1097/MEG.0000000000000761
Review Articles

The incidence of Crohn’s disease (CD) has been reported to increase. The aim of this review is to perform a comprehensive literature search of population-based studies focused on the natural history of paediatric-onset CD. A literature search of English and non-English language publications listed in the electronic database of MEDLINE (source PUBMED) and EMBASE from 1935 to 2016 was performed. Population-based studies or national cohorts reporting data on the short-term or long-term disease course of paediatric CD were included. Forty-nine paediatric and 15 nonpaediatric studies on CD have been identified. Up to one-third of children with inflammatory behaviour developed bowel complications more than 5 years after diagnosis. From 48 to 88% of children have experienced at least one corticosteroid course irrespective of the period of diagnosis and up to one-third became steroid dependent. Immunosuppressive preparations were used earlier and more frequently in newer than older cohorts (68 vs. 32% at 5 years) and more than one-third of children have received biological treatment early in the disease course. A decline in the surgery rate might be observed in more recent compared with older unselected populations. The relative risk of cancer in childhood-onset CD as well as the risk of death seem to have increased. Childhood-onset CD seems to be an aggressive phenotype of the disease. Compared with older cohorts, a trend towards decreasing surgical rate can be observed in newer cohorts paralleled by an increase in immunomodulator use and biologicals. Nevertheless, the causative role has yet to be investigated.

aIBD Clinical and Research Centre, ISCARE

bInstitute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic

cEPICOM, European Crohn & Colitis Organisation

dGastroenterology Unit, EPIMAD Registry, Amiens University Hospital, University of Picardie Jules Verne, Amiens

eGastroenterology Unit, Inserm U954, Nancy University and Hospital, Nancy

fPublic Health, Epidemiology and Economic Health, EPIMAD Registry, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional

gLille Inflammation Research International Center LIRIC – UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe IBD and Environmental factors: Epidemiology and Functional Analyses, Lille University, Lille, France

hDepartment of Emergency, Unit of Gastroenterology, AOU Careggi, Florence, Italy

iFirst Department of Medicine, Semmelweis University, Budapest, Hungary

Correspondence to Dana Duricova, MD, IBD Clinical and Research Centre, ISCARE, Jankovcova 1569/2c, Prague 7, 170 00 Prague, Czech Republic Tel: +420 234 770 299; fax: +420 234 770 300; e-mail:

Received June 7, 2016

Accepted August 25, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.