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Risk Factors for Disease Behavior Evolution and Efficacy of Biologics in Reducing Progression in Pediatric Patients with Nonstricturing, Nonpenetrating Crohn's Disease at Diagnosis: A Single-Center Experience in Korea
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Type
Academic journal
Author
Kim Hyun Jin (Department of Pediatrics Chungnam National University Hospital Daejeon Korea.) Oh Seak Hee (Department of Pediatrics Asan Medical Center Children’s Hospital University of Ulsan College of Med) Lee Sung Hee (Department of Pediatrics Asan Medical Center Children’s Hospital University of Ulsan College of Med)
Journal
거트앤리버 발행위원회 Gut and Liver Gut and Liver 제15권 제6호 KCI Accredited Journals SCOPUS
Published
2021.11
Pages
851 - 857 (7page)
DOI
10.5009/gnl20279

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Risk Factors for Disease Behavior Evolution and Efficacy of Biologics in Reducing Progression in Pediatric Patients with Nonstricturing, Nonpenetrating Crohn's Disease at Diagnosis: A Single-Center Experience in Korea
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Background/Aims: Recently, the treatment of Crohn’s disease (CD) has changed to a treat-to-target strategy, in which disease progression is prevented with early intervention. We analyzed the long-term evolution of nonstricturing, nonpenetrating (B1) disease at diagnosis and factors related to disease evolution in pediatric CD. Methods: We retrospectively analyzed 402 patients between 2000 and 2013 who were younger than 18 years and had B1 disease at CD diagnosis. The median follow-up was 6.1 years (range, 1 to 13 years). The cumulative probabilities of developing stricturing (B2) or penetrating (B3) disease and associations between risk factors and disease behavior evolution were evaluated. Results: Among the 402 patients, 75 (18.7%) had B2 or B3 disease by the final follow-up. The cumulative probabilities of disease behavior evolution were 18.3%, 34.3%, and 50.9% at 5, 10, and 13 years, respectively. Patients whose disease progressed had an increased risk of intestinal resection (hazard ratio [HR], 3.61; 95% confidence interval [CI], 2.25 to 6.03; p<0.001). First-degree family history of inflammatory bowel disease (HR, 2.38; 95% CI, 1.07 to 5.28; p=0.032), isolated ileal involvement at diagnosis (HR, 7.55; 95% CI, 1.04 to 15.57; p=0.045), and positive anti-Saccharomyces cerevisiae antibody titers (HR, 2.10; 95% CI, 1.03 to 4.25; p=0.040) were associated with disease behavior evolution. Early treatment with biologics significantly reduced disease progression (HR, 0.46; 95% CI, 0.79 to 3.39; p=0.042). Conclusions: This study suggests that early aggressive therapy should be considered in B1 behavior pediatric CD patients with risk factors of disease evolution to improve long-term outcomes.
#Pediatrics #Crohn disease #Behavior #Evolution

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References (36)

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Roda G / 2020 / Crohn’s disease / Nat Rev Dis Primers 6:22 google schola Pariente B / 2011 / Development of the Crohn’s disease digestive damage score, the Lémann score / Inflamm Bowel Dis 17:1415~1422 google schola Kim HJ / 2017 / Clinical characteristics and long-term outcomes of paediatric Crohn’s disease : a singlecentre experience / J Crohns Colitis 11:157~164 google schola Fumery M / 2019 / Long-term outcome of pediatric-onset Crohn’s disease : a population-based cohort study / Dig Liver Dis 51:496~502 google schola Colombel JF / 2020 / Outcomes and strategies to support a treat-to-target approach in inflammatory bowel disease : a systematic review / J Crohns Colitis 14:254~266 google schola

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