Surgery for children with Crohn's disease: indications, complications and outcome

Blackburn, Simon; Wiskin, Anthony E.; Barnes, C.O.; Dick, Karen; Afzal, NA; Griffiths, D.M.; Beattie, R Mark; Stanton, Michael

doi:10.1136/archdischild-2013-305214

Cited by 48 publications

(44 citation statements)

References 30 publications

(26 reference statements)

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“…12 This number was comparable with other studies reporting around 1/3 patients undergoing a surgical procedure during childhood. 17,18 In contrast to the increasing incidence of disease, the rates of paediatric surgery have not been reported to change over time. 19,20 The impact of increasing use of anti-TNF therapy on surgical procedure rates during childhood is important to guide use of these medications and understand prognoses for patients and families.…”

Section: Introductionmentioning

confidence: 99%

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

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Summary Background Anti‐tumour necrosis factor‐α (anti‐TNF) therapy use has risen in paediatric‐onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti‐TNF‐therapy and surgery. Aim To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti‐TNF‐therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact). Results Eight‐hundred‐and‐twenty‐five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD‐unclassified), mean age at diagnosis 13.6 years (1.6‐17.6), 39.6% female. The prevalence of anti‐TNF‐treated patients increased from 5.1% to 27.1% (2007‐2017), P = 0.0001. Surgical resection‐rate fell (7.1%‐1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%‐2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection‐rates were unchanged. Time from diagnosis to resection increased (1.6‐2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007‐2011 = 13.1 years, 2013‐2017 = 11.9 years, P = 0.014). Resection‐rate in anti‐TNF‐therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti‐TNF‐therapy <3 years post‐diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti‐TNF‐therapy prevalence was the only significant predictor of resection‐rate using multivariate regression (P = 0.011). Conclusions The prevalence of anti‐TNF‐therapy increased significantly, alongside a decrease in surgical resection‐rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti‐TNF‐therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.

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Section: Introductionmentioning

confidence: 99%

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

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“…110 Despite this, surgical treatment carried a 22% complication rate and a 15% recurrence rate, and 21% of patients had an unplanned return to the operating room in a recent study. 111 While medical therapy may one day render surgical therapy unnecessary, at present, the surgeon remains an integral part of the treatment team for patients with any IBD, and Crohn's disease in particular.…”

Section: Resultsmentioning

confidence: 99%

Pediatric Crohn's Disease

Allmen

2018

Clinics in Colon and Rectal Surgery

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The incidence of Crohn's disease in the pediatric population is increasing. While pediatric patients with Crohn's disease exhibit many of the characteristics of older patients, there are important differences in the clinical presentation and course of disease that can impact the clinical decisions made during treatment. The majority of children are diagnosed in the early teen years, but subgroups of very early onset and infantile Crohn's present much earlier and have a unique clinical course. Treatment paradigms follow the traditional laddered approach, but growth and development represent special considerations that must be given to pediatric-specific complications of the treatment and disease. Surgical intervention is an important component of Crohn's management and is often employed to allow improved nutritional intake or decrease reliance on medical treatments that compromise growth.

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“…Despite almost inevitable recurrence, the period of remission induced by surgery, which is affected by the anatomic distribution of inflammation [131,132] allows significant catch-up growth when it is performed prior to or at early puberty [12,132,133] and if no residual disease remains [40]. Recently, Blackburn et al [134] failed to demonstrate an increase in linear growth in children who underwent surgical procedures, mainly for stricturing disease, however, these results might be confounded by relatively advanced age at surgery and lack of data regarding pubertal stage. Mechanistically, resection of the inflamed segment reduces the inflammatory burden of the disease thus enables reinstitution of growth.…”

Section: Surgerymentioning

confidence: 99%

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

Shamir¹

2014

J Clin Cell Immunol

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Growth retardation is a common complication of pediatric inflammatory bowel disease (IBD), which may have long term effects on final adult height and carries significant social and psychological implications. Etiology may be multifactorial including undernutrition, metabolic dysregulation, inflammatory impact on hormonal growth axis and the effect of drugs such as glucocorticoids. Control of disease activity and minimizing the need for corticosteroid therapy are necessary measures in order to facilitate normal growth. However, in many cases these strategies are not sufficient. Currently, there is inconsistent evidence regarding the efficacy of available therapeutic agents to induce long-term effect on growth. The new era of biologic therapies which carries a greater potential to achieve mucosal healing, holds promise for better growth even in children with severe growth impairment. It becomes apparent that prompt recognition of growth impairment combined with aggressive tailored therapeutic approach may offer the best chance for catch-up growth. This review will discuss the definition, prevalence and mechanism of growth retardation in children with IBD and highlight the specific benefits of current therapeutic strategies.

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Surgery for children with Crohn's disease: indications, complications and outcome

Abstract: Surgery was associated with a 22% early complication rate and a 15% risk of relapse. 21% of patients required a second unplanned intra-abdominal procedure. Surgical intervention was associated with an increase in BMI SDS, but not in height SDS.

Cited by 48 publications

References 30 publications

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Pediatric Crohn's Disease

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

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