Risk Factors for Initial Surgery in Pediatric Patients With Crohn’s Disease

Gupta, Neera; Cohen, Stanley A.; Bostrom, Alan; Kirschner, Barbara S.; Baldassano, Robert N.; Winter, Harland S.; Ferry, George D.; Smith, Terry J.; Abramson, Oren; Gold, Benjamin D.; Heyman, Melvin B.

doi:10.1053/j.gastro.2006.02.003

Cited by 181 publications

(133 citation statements)

References 14 publications

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“…The hypothesis that a dysregulated immune response, likely affected by aging per se and leading to different phenotypic disease expressions of Crohn's disease, needs to be further elucidated. [29,30] . However, more recent studies of their chronological sequence have suggested early small ulcers or granulomas with ongoing progression to later sinuses and strictures complicating large ulcers [31] .…”

Section: Age-related Phenotypic Expressionmentioning

confidence: 99%

Long-term natural history of Crohn’s disease

Freeman¹

2009

WJG

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Section: Age-related Phenotypic Expressionmentioning

confidence: 99%

Long-term natural history of Crohn’s disease

Freeman¹

2009

WJG

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“…A similar lack of effect of immunomodulator therapy on 5-year surgical outcome was also reported from the same registry after comparing children with moderate-severe CD activity at presentation who received an immunomodulator either within the first 3 months after diagnosis, or between 3 months and 1 year of diagnosis [15]. Another US cohort, assessed retrospectively, also did not demonstrate any effect of thiopurine therapy on the risk of intestinal surgery [16]. …”

Section: Effect Of Thiopurines On Surgical Ratesmentioning

confidence: 56%

Can We Change the Natural History of Crohn's Disease with Early Immunomodulation?

Markowitz

2014

Dig Dis

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In both children and adults, the natural history of Crohn's disease (CD) is characterized by relapsing and remitting bouts of intestinal inflammation, often associated with a progressive shift from inflammatory to complicated stricturing or penetrating disease behavior. The past 2 decades have seen a dramatic shift in therapeutic approach with the increasingly common use of early thiopurine immunomodulation. These maintenance medications were initially introduced primarily as corticosteroid-sparing agents capable of minimizing recurrent flares of inflammatory disease and have proven to be quite efficacious. Increasing evidence suggests, however, that thiopurines may only delay rather than prevent the development of complicated disease behavior. Data from both adult and pediatric CD populations from around the world are reviewed in terms of the effect of early immunomodulation on progression to complicated disease behavior, need for surgery, and prevention of recurrent disease after resection. The effect of thiopurines on the growth of children is also reviewed.

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“…A distinct phenotype of EO-IBD is described, with a high familial aggregation in UC and greater tendency to develop colonic disease [4]. In different studies, young age at diagnosis was described as a predictive parameter of a complicated disease course [11], and of an increased risk for future immunosuppressive therapy [12], surgery, and recurrence rates [13].…”

Section: Discussionmentioning

confidence: 99%