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Long-term Outcome After First Intestinal Resection in Pediatric-onset Crohnʼs Disease

Abstract : Background To describe long-term postoperative evolution of pediatric-onset Crohn's disease (CD) and identify predictors of outcome we studied a population-based cohort (1988–2004) of 404 patients (0–17 years), of which 130 underwent surgery. Methods Risks for a second resection and first need for immunosuppressors (IS) and/or biologics were estimated by survival analysis and Cox models used to determine predictors of outcome. Impact of time of first surgery on nutritional catch-up was studied using regression. Results In all, 130 patients (70 females) with a median age at diagnosis of 14.2 years (interquartile range: 12–16) were followed for 13 years (9.4–16.6). Probability of a second resection was 8%, 17%, and 29% at 2, 5, and 10 years, respectively. In multivariate analysis, age <14, stenosing (B2) and penetrating (B3) behaviors and upper gastrointestinal location (L4) at diagnosis were associated with an increased risk of second resection. Probability of receiving IS or biologics was 18%, 34%, and 47% at 2, 5, and 10 years, respectively. In multivariate analysis, L4 was a risk factor for requiring IS or biologics, while surgery within 3 years after CD diagnosis was protective. Catch-up in height and weight was better in patients who underwent surgery within 3 years after CD diagnosis than those operated on later. Conclusions In this pediatric-onset CD study, mostly performed in a prebiologic era, a first surgery performed within 3 years after CD diagnosis was associated with a reduced need for IS and biologics and a better catch-up in height and weight compared to later surgery.
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https://hal.univ-lorraine.fr/hal-01704425
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Submitted on : Thursday, February 8, 2018 - 2:33:42 PM
Last modification on : Tuesday, November 3, 2020 - 3:54:06 PM

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Médina Boualit, Julia Salleron, Dominique Turck, Mathurin Fumery, Guillaume Savoye, et al.. Long-term Outcome After First Intestinal Resection in Pediatric-onset Crohnʼs Disease. Inflammatory Bowel Diseases, Lippincott, Williams & Wilkins, 2013, 19 (1), pp.7 - 14. ⟨10.1002/ibd.23004⟩. ⟨hal-01704425⟩

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