Long-term outcome of pediatric-onset Crohn’s disease: A population-based cohort study

Autor: Mathurin Fumery, Guillaume Savoye, Benjamin Pariente, Djamal Djeddi, Claire Spyckerelle, Hélène Sarter, Anais Peneau, Delphine Ley, Olivier Mouterde, Guillaume Bouguen, Corinne Gower-Rousseau, Dominique Turck, Jean-Louis Dupas
Přispěvatelé: Service d'Hépato Gastroenterologie [CHU Amiens-Picardie], CHU Amiens-Picardie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lille Inflammation Research International Center - U 995 (LIRIC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Unité Pédiatrique [Saint-Vincent de Paul Lille], Hôpital Saint-Vincent de Paul, Pédiatrie médicale et médecine de l'adolescent [Amiens], Service de pédiatrie médicale et médecine de l'adolescent [Rouen], CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Institut National de la Recherche Agronomique (INRA)-Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Gastroenterologie [CHRU Lille], Hôpital Claude Huriez [Lille], CHU Lille, Service d'Epidémiologie et de Santé Publique [Lille], Registre EPIMAD, Normandie Université (NU)-Normandie Université (NU)-CHU Amiens-Picardie-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lille Inflammation Research International Center (LIRIC), Service d'Hépato-Gastroentérologie [Rouen], Normandie Université (NU)-Normandie Université (NU)-Hôpital Charles Nicolle [Rouen]-CHU Rouen, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Amiens-Picardie, CCSD, Accord Elsevier, Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Adolescent
Natural history
Disease
Severity of Illness Index
Gastroenterology
Crohn
03 medical and health sciences
Population based cohort
0302 clinical medicine
Crohn Disease
Adrenal Cortex Hormones
Risk Factors
Neoplasms
Internal medicine
Humans
Medicine
Registries
Age of Onset
Child
Proportional Hazards Models
Pediatric
Hepatology
business.industry
Proportional hazards model
Mortality rate
Cancer
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
medicine.disease
[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Population base
3. Good health
Pediatric onset Crohn's disease
030220 oncology & carcinogenesis
Multivariate Analysis
Cohort
Disease Progression
Female
030211 gastroenterology & hepatology
France
business
Immunosuppressive Agents
Follow-Up Studies
Zdroj: Digestive and Liver Disease
Digestive and Liver Disease, 2019, 51 (4), pp.496-502. ⟨10.1016/j.dld.2018.11.033⟩
Digestive and Liver Disease, WB Saunders, 2019, 51 (4), pp.496-502. ⟨10.1016/j.dld.2018.11.033⟩
ISSN: 1590-8658
DOI: 10.1016/j.dld.2018.11.033
Popis: Background Pediatric-onset Crohn’s disease (CD) may represent a more severe form of disease. The aim of this study was to describe long-term outcome and identify associated risk factors of complicated behavior in a large population-based pediatric-onset CD cohort. Patients and methods Cases included all patients recorded in the EPIMAD registry diagnosed with definite or probable CD between January 1988 and December 2004, under the age of 17 years at the time of diagnosis, with at least two years of follow-up. Results Five hundred and thirty-five patients were included. Median follow-up was 11.1 years [IQR, 7.3–15.0]. At the end of follow-up, 8% (n = 44) of patients had pure ileal disease (L1), 8% (n = 44) had pure colonic disease (L2), and 83% (n = 439) had ileocolonic disease (L3). L4 disease and perianal disease were observed in 42% (n = 227) and 16% (n = 85) of patients, respectively. At the end of follow-up, 58% (n = 308) of patients presented complicated disease behavior (B2, 39% and B3, 19%), and 42% (n = 163) of patients with inflammatory behavior at diagnosis had evolved to complicated behavior. During follow-up, 86% of patients (n = 466) received at least one course of corticosteroids, 67% (n = 357) of patients had been exposed to immunosuppressants and 35% (n = 187) of patients received at least one anti-TNF agent. Forty-three percent (n = 230) of patients underwent at least one intestinal resection. The overall mortality rate was 0.93% and the SMR was 1.6 [0.5–3.8] (p = 0.20). Five cancers were reported with a crude cancer incidence rate of 1.1% and an SIR of 3.3 [1.2–7.0] (p = 0.01). In a multivariate Cox model, ileal (HR, 1.87 [1.09–3.21], p = 0.022) or ileocolonic (HR, 1.54 [1.01–2.34], p = 0.042) and perianal lesions at diagnosis (HR, 1.81 [1.13- 2.89], p = 0.013) were significantly associated with complicated behavior. Conclusion About 80% of patients with pediatric-onset CD presented extensive ileocolonic disease during follow-up. The majority of patients evolved to complicated behavior. Surgery, cancer and mortality were observed in 43%, 0.9% and 0.9% of patients, respectively.
Databáze: OpenAIRE
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