Perianal Crohn Disease Is More Common in Children and Is Associated With Complicated Disease Course Despite Higher Utilization of Biologics: A Population-based Study From The epidemiology group of the Israeli IBD Research Nucleus (epiIIRN).
Journal
Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801
Titre abrégé: J Pediatr Gastroenterol Nutr
Pays: United States
ID NLM: 8211545
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
23
2
2022
medline:
22
7
2022
entrez:
22
2
2022
Statut:
ppublish
Résumé
Both perianal and pediatric-onset Crohn disease (CD) disease are associated with complicated disease course and higher drug utilization. we aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course. We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing perianal CD (PCD) and its severity according to the association with simple and complex perianal disease. A total of 12,905 patients were included (2186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1530 (12%) patients, with higher incidence in children (308 [14%] children vs 1222 adults [11%]; P < 0.001). Children had higher incidence of severe PCD (141/308 [47%] vs 433/1222 [35%]; P < 0.001). At 5 years, children with PCD were more likely than adults to be treated with biologics (212 [69%] vs 515 [42%]; odds ratio [OR] 2.6 [95% confidence interval (CI) 1.6-4.0]; P < 0.001) and immunomodulators (238 [74%] vs 643 [53%]; OR 2.8 [95% CI 2.1-3.6]; P < 0.001). PCD in children was still associated with poorer disease outcomes as shown for surgeries (36 [12%] vs 93 [8%]; P = 0.02) and steroid-dependency (52 [17%] vs 156 [13%]; P < 0.001). Multivariable modeling indicated that the severity of PCD is a stronger predictor of disease course than age. PCD is more common in pediatric-onset CD and is associated with higher drug utilization and worse disease outcomes, in large due to higher rate of severe PCD in children.
Sections du résumé
BACKGROUND AND OBJECTIVES
Both perianal and pediatric-onset Crohn disease (CD) disease are associated with complicated disease course and higher drug utilization. we aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course.
METHODS
We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing perianal CD (PCD) and its severity according to the association with simple and complex perianal disease.
RESULTS
A total of 12,905 patients were included (2186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1530 (12%) patients, with higher incidence in children (308 [14%] children vs 1222 adults [11%]; P < 0.001). Children had higher incidence of severe PCD (141/308 [47%] vs 433/1222 [35%]; P < 0.001). At 5 years, children with PCD were more likely than adults to be treated with biologics (212 [69%] vs 515 [42%]; odds ratio [OR] 2.6 [95% confidence interval (CI) 1.6-4.0]; P < 0.001) and immunomodulators (238 [74%] vs 643 [53%]; OR 2.8 [95% CI 2.1-3.6]; P < 0.001). PCD in children was still associated with poorer disease outcomes as shown for surgeries (36 [12%] vs 93 [8%]; P = 0.02) and steroid-dependency (52 [17%] vs 156 [13%]; P < 0.001). Multivariable modeling indicated that the severity of PCD is a stronger predictor of disease course than age.
CONCLUSION
PCD is more common in pediatric-onset CD and is associated with higher drug utilization and worse disease outcomes, in large due to higher rate of severe PCD in children.
Identifiants
pubmed: 35192577
doi: 10.1097/MPG.0000000000003422
pii: 00005176-202206000-00014
doi:
Substances chimiques
Biological Products
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
788-793Informations de copyright
Copyright © 2022 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Références
Atia O, Asayag N, Focht G, et al. Perianal Crohn's disease is associated with poor disease outcome: a nationwide study from the epiIIRN cohort. Clin Gastroenterol Hepatol 2021; 20:e484–e495.
Wewer MD, Zhao M, Nordholm-Carstensen A, et al. The incidence and disease course of perianal Crohn's disease: a Danish Nationwide Cohort Study, 1997–2015. J Crohns Colitis 2021; 15:5–13.
Ye BD, Yang SK, Cho YK, et al. Clinical features and long-term prognosis of Crohn's disease in Korea. Scand J Gastroenterol 2010; 45:1178–1185.
Song EM, Lee HS, Kim YJ, et al. Incidence and outcomes of perianal disease in an Asian population with Crohn's disease: a nationwide population-based study. Dig Dis Sci 2020; 65:1189–1196.
van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn's disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis 2020; 15:171–194.
Torres J, Bonovas S, Doherty G, et al. ECCO guidelines on therapeutics in Crohn's disease: medical treatment. J Crohns Colitis 2020; 14:4–22.
Atia O, Orlanski-Meyer E, Lujan R, et al. Improved outcomes of pediatric and adult Crohn's disease and association with emerging use of biologics – a nationwide study from the epi-IIRN. J Crohns Colitis 2021.
Friedman MY, Leventer-Roberts M, Rosenblum J, et al. Development and validation of novel algorithms to identify patients with inflammatory bowel diseases in Israel: an epi-IIRN group study. Clin Epidemiol 2018; 10:671–681.
Ricciuto A, Fish JR, Tomalty DE, et al. Diagnostic delay in Canadian children with inflammatory bowel disease is more common in Crohn's disease and associated with decreased height. Arch Dis Child 2018; 103:319–326.
Banerjee R, Pal P, Girish BG, et al. Risk factors for diagnostic delay in Crohn's disease and their impact on long-term complications: how do they differ in a tuberculosis endemic region? Aliment Pharmacol Ther 2018; 47:1367–1374.
Schwartz DA, Loftus EV, Tremaine WJ, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122:875–880.
Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal Crohn's disease in a population-based cohort. Dis Colon Rectum 2012; 55:773–777.
Schwartz DA, Tagarro I, Carmen Díez M, et al. Prevalence of fistulizing Crohn's disease in the United States: estimate from a systematic literature review attempt and population-based database analysis. Inflamm Bowel Dis 2019; 25:1773–1779.
Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn's disease: a population-based cohort study. Gastroenterology 2008; 135:1106–1113.
Gupta N, Bostrom AG, Kirschner BS, et al. Incidence of stricturing and penetrating complications of Crohn's disease diagnosed in pediatric patients. Inflamm Bowel Dis 2010; 16:638–644.
Adler J, Dong S, Eder SJ, et al. Perianal Crohn disease in a large multicenter pediatric collaborative. J Pediatr Gastroenterol Nutr 2017; 64:e117–e124.
Pigneur B, Seksik P, Viola S, et al. Natural history of Crohn's disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis 2010; 16:953–961.
Zwintscher NP, Shah PM, Argawal A, et al. The impact of perianal disease in young patients with inflammatory bowel disease. Int J Colorectal Dis 2015; 30:1275–1279.
Assa A, Amitai M, Greer ML, et al. Perianal pediatric Crohn disease is associated with a distinct phenotype and greater inflammatory burden. J Pediatr Gastroenterol Nutr 2017; 65:293–298.
Herman Y, Rinawi F, Rothschild B, et al. The characteristics and longterm outcomes of pediatric Crohn's disease patients with perianal disease. Inflamm Bowel Dis 2017; 23:1659–1665.
Wang H, Wu Y, Ye C, et al. Perianal disease onset age is associated with need for abdominal surgery in perianal Crohn's disease: a ten-year observational study in China. Res Square 2021; DOI: 10.21203/rs.3.rs-154364/v1.
doi: 10.21203/rs.3.rs-154364/v1