Changes in the clinical phenotype and behavior of pediatric luminal Crohn's disease at diagnosis in the last decade

Sassine, Samuel; Robichaud, Mathieu Savoie; Lin, Yi; Djani, L; Cambron‐Asselin, Christine; Qaddouri, Marwa; Zekhnine, S Fadela; Grzywacz, Kelly; Groleau, Véronique; Dirks, M; Drouin, Éric; Halac, Ugur; Marchand, Valérie; Girard, Chloé; Courbette, Olivier; Patey, Natalie; Soglio, Dorothée Dal; Deslandres, Colette; Jantchou, P

doi:10.1016/j.dld.2021.09.012

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…Little is known about the pathophysiological process of granuloma formation, but granulomas may play a role as sites of antigen presentation to memory T cells (45). It has been demonstrated that patients had more granulomas on biopsies in recent years, suggesting that a certain phenotype of the disease has become more prevalent (46). One study found that CD patients with granulomas had more severe symptoms at baseline and were diagnosed at a younger age (47).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

et al. 2022

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INTRODUCTION:There is currently little knowledge on factors associated with the relapse of Crohn's disease (CD) in children. The aims of this study were to describe the risk factors associated with relapse in pediatric CD and the changes in the relapse rate over the past decade.METHODS:Patients younger than 18 years and diagnosed between 2009 and 2019 were included in this retrospective cohort study. Clinical, endoscopic, histological, and laboratory data, as well as induction and maintenance treatments, were collected from the medical records. Survival analyses and Cox regression models were used to assess the impact of these risk factors on relapse.RESULTS:Six hundred thirty-nine patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of the patients diagnosed between 2009 and 2014 relapsed as compared with 49.1% of the patients diagnosed between 2015 and 2019 (P < 0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio [aHR] = 1.52, P = 0.0007), exposure to oral 5-ASA (aHR = 1.44, P = 0.04), use of immunomodulatory agents compared with tumor necrosis factor-alpha inhibitors (methotrexate aHR = 1.73, P = 0.003; thiopurines aHR = 1.63, P = 0.002), presence of granulomas (aHR = 1.34, P = 0.02) and increased eosinophils on intestinal biopsies (aHR = 1.36, P = 0.02), high levels of C-reactive protein (aHR = 1.01, P < 0.0001) and fecal calprotectin (aHR = 1.08, P < 0.0001), and low serum infliximab levels (aHR = 2.32, P = 0.001).DISCUSSION:Relapse of pediatric CD has decreased in the past decade. The risk of relapse is significantly associated with clinical, endoscopic, histological, and laboratory variables and treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

et al. 2022

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Pan-enteric Capsule Endoscopy to Characterize Crohn’s Disease Phenotypes and Predict Clinical Outcomes in Children and Adults: The Bomiro Study

Oliva,

Veraldi,

Russo

et al. 2024

Inflammatory Bowel Diseases

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Background Pan-enteric capsule endoscopy (PCE) provides useful information for the management of Crohn’s disease (CD), especially in children. No study has evaluated the ability of PCE to characterize CD phenotypes and outcomes in children and adults. Methods In a prospective multicenter observational study, we recruited patients with CD >6 years from 4 centers in Italy. Patients underwent clinical, biomarker assessment and PCE. Lesions were graded using the PCE system. For each segment, the most common lesion (MCL), the most severe lesion (MSL), and the extent of involvement were defined. Disease severity, extent, and clinical outcomes were compared between children and adults. A logistic regression analysis was used to identify predictive factors for negative outcomes in both age groups. Results One hundred ninety-four consecutive patients (adults/children: 144/50) were evaluated for a total of 249 procedures. Children were more likely to have extensive disease, particularly in the colon. Higher MCL scores were independently associated with treatment escalation (odds ratio [OR], 4.09; 95% CI, 1.80-9.25; P = .001), while >30% disease extent was more indicative of clinical and endoscopic relapse (OR, 2.98; 1.26-7.08; P = .013). Disease extent was the only factor associated with endoscopic recurrence in children (OR, 4.50; 95% CI, 1.47-13.77; P = .008), while severe lesions in adults provided a better predictor of treatment escalation (OR, 4.31; 95% CI, 1.52-12.1; P = .006). Postexamination, PCE contributed to a change of therapy in 196/249 (79%) of the procedures. Conclusions PCE allowed the characterization of CD phenotypes in children and adults by assessing disease severity and extent, which are of different importance in predicting clinical outcomes in these age groups.

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Changes in the clinical phenotype and behavior of pediatric luminal Crohn's disease at diagnosis in the last decade

Cited by 2 publications

References 38 publications

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

Pan-enteric Capsule Endoscopy to Characterize Crohn’s Disease Phenotypes and Predict Clinical Outcomes in Children and Adults: The Bomiro Study

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