The natural history of pediatric Crohn's disease and risk factors necessitating surgery have not been thoroughly described.
Dr Gwenola Vernier–Massouille and colleagues from France identified 404 Crohn’s disease patients in a geographically derived incidence cohort diagnosed from 1988 to 2002.
The researchers reported that the median follow-up time was 84 months.
The most frequent disease location at diagnosis was the terminal ileum/colon.
Follow-up was characterized by disease extension in 31% of children.
|Kaplan–Meier survival estimates of the cumulative incidence of surgery were 20% at 3 years|
The team observed complicated behavior in 29% of children at diagnosis, and 59% at follow-up.
Kaplan–Meier survival estimates of the cumulative incidence of surgery were 20% at 3 years, and 34% at 5 years from diagnosis.
Multivariate Cox models showed that both structuring behavior at diagnosis, and treatment with corticosteroids were associated with increased risk for surgery.
However, treatment with azathioprine was associated with decreased risk.
Azathioprine was introduced earlier in the course of disease in patients not undergoing surgery than in patients requiring surgery.
Dr Vernier–Massouille’s team concluded, “Pediatric Crohn's disease was characterized by frequent occurrence, with time, of a severe phenotype with extensive, complicated disease.”
“Immunosuppressive therapy may improve the natural history of this disease and decrease the need for performing surgery.”