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Role of Sex in the Treatment and Clinical Outcomes of Pediatric Patients With Inflammatory Bowel Disease

Lee, Grace J.*; Kappelman, Michael D.; Boyle, Brendan; Colletti, Richard B.§; King, Eileen||; Pratt, Jesse M.||; Crandall, Wallace V.

Journal of Pediatric Gastroenterology and Nutrition: December 2012 - Volume 55 - Issue 6 - p 701–706
doi: 10.1097/MPG.0b013e318266241b
Original Articles: Gastroenterology

Objective: To examine sex differences in medical therapy and clinical outcomes in pediatric patients with inflammatory bowel disease (IBD).

Methods: We performed a cross-sectional analysis of children with Crohn disease (CD) and ulcerative colitis (UC) using data from the ImproveCareNow Network collected between May 2007 and May 2010. Clinical remission, disease severity, body mass index (BMI) z scores, normal height velocity, and medication use were analyzed by sex and age.

Results: One thousand four hundred nine patients were included (993 had CD and 416 had UC). No significant sex differences were found in disease severity, BMI, height velocity, or use of medications. Further analysis of combination therapy with infliximab + 6-mercaptopurine/azathioprine and infliximab + methotrexate also did not reveal any differences. No sex differences were found after mediation use was stratified by age (those younger than 13 years and those 13 years old or older).

Conclusions: In this sample of CD and UC pediatric patients, no significant sex differences were found in disease severity, BMI, height velocity, or medication use. Our data do not support the use of sex as a major factor in patient risk stratification for children with IBD. In addition, despite concerns for sex-specific complications of some medications, our analysis did not suggest any sex differences in medication use.

*Pediatric Gastroenterology Fellowship Program, Nationwide Children's Hospital, Columbus, OH

Division of Gastroenterology and Hepatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC

Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH

§Department of Pediatrics, University of Vermont, Burlington, VT

||Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Grace J. Lee, MD, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 (e-mail:

Received 23 December, 2011

Accepted 14 June, 2012

Participating ImproveCareNow centers and their physician leaders are Advocate Lutheran General Children's Hospital, James Berman; Arkansas Children's Hospital, George Fuchs; Arnold Palmer Children's Hospital, Devendra Mehta/Jeffrey Bornstein; Children's Healthcare of Atlanta/Emory Children's Center, Bess T. Schoen; Children's Hospital Boston, Leslie Higuchi; Children's Hospital of Colorado, Deborah Neigut/Edward Hoffenberg; Children's Hospital of the King's Daughters, Marc Tsou; Children's Hospital of Philadelphia, Andrew Grossman/Robert Baldassano; Children's Mercy Hospital, William San Pablo; Cincinnati Children's Hospital Medical Center, Shehzad Saeed/Ted Denson; Great Ormond Street Hospital, Mamoun Elawad; Inova Pediatric Digestive Disease Center, Ian Leibowitz/Lynn Duffy; Levine Children's Hospital, Victor Piñeiro; Maine Medical Center, Rebecca Carey; Massachusetts General Children's Hospital, George Russell/Esther Israel; Mayo Clinic, Jeanne Tung; Nationwide Children's Hospital, Wallace Crandall/Brendan Boyle; Nemours Children's Clinic, Fernando del Rosario/David Milov; Northwest Pediatric Gastroenterology, LLC, Jacqueline Fridge; Oakland Children's Hospital, Sabina Ali; Oklahoma University Medical Center, John Grunow; Pediatric Gastroenterology and Nutrition Associates, Howard Baron; Texas Children's Hospital, Seema Mehta/George Ferry; University of Michigan-Ann Arbor, Jeremy Adler; University of Minnesota, Boris Sudel; University of North Carolina at Chapel Hill, Michael Kappelman/Sandra Kim; UT Southwestern Medical Center, Ashish Patel; Vermont Children's Hospital, Richard Colletti.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN