NASPGHAN Clinical Report on Postoperative Recurrence in Pediatric Crohn Disease

Abstract

Pediatric Crohn disease is characterized by clinical and endoscopic relapses. The inflammatory process is considered to be progressive and may lead to strictures, fistulas, and penetrating disease that may require surgery. In addition, medically refractory disease may be treated by surgical resection of inflamed bowel in an effort to reverse growth failure. The need for surgery in childhood suggests severe disease and these patients have an increased risk for recurrent disease and potentially more surgery. Data show that up to 55% of patients had clinical recurrence in the first 2 years after initial surgery. The current clinical report on postoperative recurrence in pediatric Crohn disease reviews the risk factors for early surgery and postoperative recurrence, operative risk factors for recurrence, and prevention and monitoring strategies for postoperative recurrence. We also propose an algorithm for postoperative management in pediatric Crohn disease.

Histology at diagnostic gastroscopy predicts outcome after intestinal resection in pediatric Crohn's disease

“…In our study, gender was not associated with POR risk, similar to studies in adults with CD 2,14–16 . There was a trend towards women having a higher recurrence rate, consistent with previous studies in pediatric CD 28,29 .…”

“…In our study, gender was not associated with POR risk, similar to studies in adults with CD. 2,[14][15][16] There was a trend towards women having a higher recurrence rate, consistent with previous studies in pediatric CD. 28,29 We found that there was no significant difference in mean age of diagnosis between the recurrence and nonrecurrence CD patients.…”

“…2,[7][8][9] In pediatric CD, there are no unequivocal predictors of POR in the current literature. 10 Up to 71% of pediatric CD patients have upper GI involvement, [11][12][13][14][15] This is significantly more common in childhood-onset CD than in adult-onset CD. 13 Upper GI location at diagnosis may increase risk for POR as it indicates disease extension and has been associated with poorer outcomes.…”

Tailored Medical Management of the Complex Postoperative Crohn's Disease Patient

“…[1][2][3] Similar rates are seen in studies evaluating only pediatric onset Crohn's disease. 4 Furthermore, both referral center and population-based studies suggest that there has been minimal to no decrease in the rate of Crohn's disease surgery since the introduction of biologic agents. 3 Unfortunately, such surgery is usually not curative as Crohn's disease typically recurs at some point in the postoperative course with anywhere from 35 to 70% of patients requiring repeat surgery within 10 years.…”

Pediatric Inflammatory Bowel Disease

“…Pediatric IBD patients should be screened frequently for these disorders, as well as for impairments in social functioning, and referred appropriately [13]. A surgeon should be consulted for those who fail medical management or have disease-related complications that require it, such as dysplasia, perforations, and obstructions [14,15].…”