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Title: Perianal Pediatric Crohn Disease Is Associated With a Distinct Phenotype and Greater Inflammatory Burden.
Authors: Assa, Amit
Amitai, Michal
Greer, Mary-Louise
Castro, Denise A
Kuint, Ruth C
Martínez-León, Maria
Herman-Sucharska, Izabela
Coppenrath, Eva
Anupindi, Sudha
Towbin, Alexander
Moote, Douglas
Konen, Osnat
Pratt, Li-Tal
Griffiths, Anne
Turner, Dan
ImageKids Study Group
metadata.dc.subject.mesh: Adolescent
Anal Canal
Child, Preschool
Crohn Disease
Cross-Sectional Studies
Databases, Factual
Logistic Models
Longitudinal Studies
Rectal Fistula
Severity of Illness Index
Issue Date: 2017
Abstract: Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults. Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months. Of the 234 included patients (mean age 14.2 ± 2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ± 0.7 vs 4.5 ± 0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings. Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.
metadata.dc.identifier.doi: 10.1097/MPG.0000000000001484
Appears in Collections:Producción 2020

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