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COLONIC CROHN’S DISEASE IS ASSOCIATED WITH A PEJORATIVE DISEASE COURSE OF PEDIATRIC-ONSET CROHN'S DISEASE: A TWO DECADES POPULATION-BASED STUDY

Mathurin Fumery 1, Guillaume Savoye 2, Delphine Ley 3, Claire Dupont-Lucas 4, Valérie Bertrand 5, pauline wils 6, Nathalie Guillon 6, Hélène Sarter 3, Corinne Gower-Rousseau 7, Dominique Turck 8, Ariane Leroyer 6

Affiliations

1 Amiens University Hospital, Amiens, France

2 Rouen University Hospital, Rouen, France

3 Lille University Hospital, Lille, France

4 Caen University Hospital, Caen, France

5 Le Havre Hospital, Le Havre, France

6 CHRU Lille, Lille Cedex, France

7 CHRU Lille Hopital Huriez, Lille Cedex, France

8 Lille University Hospital Faculty of Medicine, Lille, France

Summary

AI Generated

In pediatric-onset inflammatory bowel disease, colonic Crohn's disease differs from ileal Crohn's disease in clinical presentation, complications, and treatment exposure over five years of follow-up.

Colonic CD patients had higher rates of hospitalization (39% vs 22% at 5 years), corticosteroid exposure (69% vs 55%), immunosuppressant exposure (61% vs 47%), and anti-TNF exposure (35% vs 16%) compared to ileal CD.
Ileal CD was associated with significantly higher surgical risk at 5 years (37% vs 13% for colonic CD), while colonic CD had higher risk of perianal lesions (HR 2.11) and lower risk of luminal fistula (HR 0.41).
At diagnosis, bloody stools were present in 44.4% of colonic CD versus 14.9% of ileal CD patients, and granulomas were identified more frequently in colonic CD (31.2% vs 12.6%).
Colonic CD showed higher prevalence of extra-intestinal manifestations including articular and cutaneous involvement, and greater risk of disease extension to ileocolonic location (37% vs 14% at 5 years).
The study analyzed 215 ileal CD, 234 colonic CD, and 337 UC patients from a population-based pediatric registry with follow-up from 1988 to 2013.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Crohn's disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset IBD.

Aims & Methods

All children (< 17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were followed retrospectively until 2013. The presentation at diagnosis, the risks of complications, surgery, hospitalization and exposure to different treatments in ileal CD (L1), colonic CD (L2) and UC were compared. Disease location was defined at diagnosis. In case of extension of the disease (L1 or L2 to L3), follow-up was censored.

Results

A total of 215 L1 patients, 234 L2 patients and 337 UC patients were included. At diagnosis, the proportion of male (L1 53.5%; L2 53.4%; UC 42.7%; p=0.012), age at diagnosis (15.0; 13.7; 14.0 years; p=0.003), family history of IBD (12.6%; 12.7%; 5.0%; p=0.005), diagnostic delay (3.0; 3.0; 2.0 months; p=0.001) and smoking prevalence (11.6%; 8.1%; 5.6%; p=0.041) were different between the three groups. Over the study period, incidence of L1, L2 and UC were 0.65 [0.57-0.74], 0.71 [0.62-0.81] and 1.02 [0.92-1.14] per 100,000 person-years, respectively. Bloody stool and diarrhea at diagnosis was observed in 14.9% respectively; 44.4%; and 91.1% (p < 0.001) and 47.0%; 71.8%; and 65.0% (p < 0.001) of L1, L2 and UC. At diagnosis, granuloma was identified in 12.6% of L1 patients and 31.2% of L2 patients (p<0.001). The risk of extension to L3 was significantly higher in the L2 group than in the L1 group (at 5 years - 37% vs. 14%, p<0.001). L2 location was associated with a lower risk of luminal fistula (HR 0.41 [0.21-0.79], p=0.008) but a higher risk of anoperineal lesion (HR 2.11 [1.29-3.45], p=0.003). The prevalence of extra-intestinal manifestations, articular (p<0.001) and cutaneous (p<0.001) was higher in L2 CD. While the risk of surgery was significantly higher in case of L1 location (at 5 years - 37%, 13% and 13%; p<0.001), the risk of hospitalization (at 5 years - 22%, 39% and 33%; p=0.01), exposure to corticosteroids (at 5 years - 55%, 69% and 67%; p<0.001), immunosuppressants (at 5 years - 47%, 61% and 42% - p<0.001) and anti-TNF (at 5 years - 16%, 35% and 22%; p<0.001) were higher in case of L2 location.

Conclusion

The clinical presentation and evolution of ileal and colonic CD at diagnosis differ significantly. Colonic location is associated with a high risk of perianal CD, extra-intestinal manifestations, hospitalization and exposure to steroids, immunosuppressants and anti-TNFs. These differences could justify different therapeutic approaches in the future.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

What else is cooking in IBD? (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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MACHINE LEARNING-DRIVEN MULTIMODAL RAMAN SPECTROSCOPY AND METABOLOMICS SIGNATURES IDENTIFY NON-INVASIVE BIOMARKERS OF INTESTINAL BARRIER INTEGRITY AND CLINICAL OUTCOMES IN INFLAMMATORY BOWEL DISEASE

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