Risk Factors for Surgery in Pediatric Patients with Crohn’s Disease

Shentova, Rayna; Kofinova, Denitza; Hadzhiyski, Petyo; Ivanova‐Todorova, Ekaterina; Yaneva, Penka; Lazarova, Elena; Baycheva, M.

doi:10.1159/000522256

Cited by 3 publications

(3 citation statements)

References 22 publications

(34 reference statements)

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“…Nevertheless, our study also identified a significantly lower risk for surgery for the age group 6–12 years compared to the age group 13–17 years indicating that the older the patient at disease onset, the higher is the risk for surgery. In addition to age, our data reveal that penetrating disease behavior (B3) might be a predictor of surgery, which corresponds to the previously described findings ( 10 , 11 , 13 , 14 ). B2 was found to show a trend towards increased risk of surgery, as previously described in the literature ( 11 , 13 , 14 ).…”

Section: Discussionsupporting

confidence: 90%

“…In addition to age, our data reveal that penetrating disease behavior (B3) might be a predictor of surgery, which corresponds to the previously described findings ( 10 , 11 , 13 , 14 ). B2 was found to show a trend towards increased risk of surgery, as previously described in the literature ( 11 , 13 , 14 ).…”

Section: Discussionsupporting

confidence: 90%

“…Our study identified perianal disease at diagnosis as a risk factor of surgery, which has also been reported in a very recent study in a small group of 57 patients ( 14 ). This is likely because specific types of severe perianal disease can be an indication for surgery ( 15 , 16 ).…”

Section: Discussionsupporting

confidence: 88%

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Predicting complications in pediatric Crohn's disease patients followed in CEDATA-GPGE registry

Klamt

Laffolie²,

Wirthgen³

et al. 2023

Front. Pediatr.

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BackgroundComplications of Crohn's disease (CD) often impair patients' quality of life. It is necessary to predict and prevent these complications (surgery, stricturing [B2]/penetrating [B3] disease behavior, perianal disease, growth retardation and hospitalization). Our study investigated previously suggested and additional predictors by analyzing data of the CEDATA-GPGE registry.MethodsPediatric patients (< 18 years) diagnosed with CD with follow up data in the registry were included in the study. Potential risk factors for the selected complications were evaluated by performing Kaplan-Meier survival curves and cox regression models.ResultsFor the complication surgery, the potential risk factors older age, B3 disease, severe perianal disease and initial therapy with corticosteroids at the time of diagnosis were identified. Older age, initial therapy with corticosteroids, low weight-for-age, anemia and emesis predict B2 disease. Low weight-for-age and severe perianal disease were risk factors for B3 disease. Low weight-for-age, growth retardation, older age, nutritional therapy, and extraintestinal manifestations (EIM) of the skin were identified as risk factors for growth retardation during the disease course. High disease activity and treatment with biologicals were predictors for hospitalization. As risk factors for perianal disease, the factors male sex, corticosteroids, B3 disease, a positive family history and EIM of liver and skin were identified.ConclusionWe confirmed previously suggested predictors of CD course and identified new ones in one of the largest registries of pediatric CD patients. This may help to better stratify patients’ according to their individual risk profile and choose appropriate treatment strategies.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

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Predicting complications in pediatric Crohn's disease patients followed in CEDATA-GPGE registry

Klamt

Laffolie²,

Wirthgen³

et al. 2023

Front. Pediatr.

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Clusters of Disease Activity and Early Risk Factors of Clinical Course of Pediatric Crohn’s Disease

Distante,

Rotulo,

Ranalli

et al. 2023

Inflammatory Bowel Diseases

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Background This study aimed to define clusters of disease activity and prognostic factors of disease course in a well-characterized cohort of children with Crohn’s disease (CD). Methods All patients from the SIGENP IBD (Italian Society of Pediatric Gastroenterology Hepatology and Nutrition Inflammatory Bowel Disease) registry with a 5-year follow-up and 6-monthly evaluation were included. Active disease was defined for each semester as follows: clinical activity (weighted Pediatric Crohn’s Disease Activity Index ≥12.5 or Mucosal Inflammation Noninvasive Index ≥8) and active disease on endoscopy (Simple Endoscopic Score for Crohn’s Disease >3 or fecal calprotectin >250 µg/g) or imaging. Formula-based clusters were generated based on previously published patterns in adults. Results Data from 332 patients were analyzed. A total of 105 (32%) experienced a quiescent disease course; 49 (15%) and 31 (9%) a moderate-to-severe chronically active and chronic intermittent disease, respectively; 104 (31%) and 43 (13%) had active disease in the first 2 years after diagnosis and remission thereafter and vice versa, respectively. Surgery at diagnosis was significantly associated with a quiescent course (odds ratio [OR], 10.05; 95% confidence interval [CI], 3.05-25.22; P=.0005), while growth impairment at the diagnosis and active disease requiring corticosteroids at 6 months were inversely related to the quiescent group (OR, 0.48; 95% CI, 0.27-0.81; P= .007; and OR, 0.35; 95% CI, 0.16-0.71; P= .005, respectively). Perianal involvement at diagnosis and moderate–severe activity at 6 months correlated with disease progression (OR, 3.85; 95% CI, 1.20-12.85; P=.02). Conclusions During the first 5 years of follow-up, one-third of children with CD experience a quiescent course. However, another one-third have a moderate-to-severe disease course. Surgery at the diagnosis is related to a quiescent course, while growth impairment and lack of response to induction therapy correlate with more severe disease activity during follow-up.

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Pediatric stricturing Crohn's disease

Boscarelli,

Bramuzzo

2024

World J Gastroenterol

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Crohn’s disease (CD) is a chronic inflammatory disease of the digestive tract. The incidence of pediatric CD is increasing and is currently 2.5–11.4 per 100000 world-wide. Notably, approximately 25% of children with CD develop stricturing CD (SCD) that requires intervention. Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions. Non-pharmacological therapeutic strategies include endoscopic balloon dilatation, stricturoplasty, and surgical resection of the strictured segment. However, strictures tend to recur postoperatively regardless of treatment modality. The lifetime risk of surgery in patients with childhood SCD remains at 50%–90%. Thus, new and emerging strategies, advanced diagnostic tools, and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.

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Risk Factors for Surgery in Pediatric Patients with Crohn’s Disease

Cited by 3 publications

References 22 publications

Predicting complications in pediatric Crohn's disease patients followed in CEDATA-GPGE registry

Predicting complications in pediatric Crohn's disease patients followed in CEDATA-GPGE registry

Clusters of Disease Activity and Early Risk Factors of Clinical Course of Pediatric Crohn’s Disease

Pediatric stricturing Crohn's disease

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