Factors That Determine Risk for Surgery in Pediatric Patients With Crohn's Disease
| Autor: | Anne M. Griffiths, Benny Kerzner, James Markowitz, Neal S. Leleiko, Gitit Tomer, Ryan Carvalho, David Kawatu, Joel R. Rosh, Jason T. Machan, Marian Pfefferkorn, Michael D. Kappelman, Marsha Kay, Jeffrey S. Hyams, Shehzad Ahmed Saeed, Maria Oliva-Hemker, Christine R. Langton, Marc Schaefer, Anthony Otley, David J. Keljo, Jonathan Evans, David R. Mack, Subra Kugathasan, Wallace Crandall, Petar Mamula, Athos Bousvaros |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Rectum Fistulotomy Risk Assessment Inflammatory bowel disease Crohn Disease medicine Strictureplasty Humans Immunologic Factors Child Abscess Digestive System Surgical Procedures Crohn's disease Hepatology business.industry Incidence Incidence (epidemiology) Infant Newborn Gastroenterology Infant Bowel resection medicine.disease digestive system diseases Surgery medicine.anatomical_structure Child Preschool Female business |
| Zdroj: | Clinical Gastroenterology and Hepatology. 8:789-794.e2 |
| ISSN: | 1542-3565 |
| DOI: | 10.1016/j.cgh.2010.05.021 |
| Popis: | Background & Aims We examined the incidence of Crohn's disease (CD)-related surgery in a multi-center, inception cohort of pediatric patients with CD. We also examined the effect of starting immunomodulator therapy within 30 days of diagnosis. Methods Data from 854 children with CD from the Pediatric Inflammatory Bowel Disease Collaborative Research Group who were diagnosed with CD between 2002 and 2008 were analyzed. Results Overall, 76 (9%) underwent a first CD-related surgery, 57 (7%) underwent a first bowel surgery (bowel resection, ostomy, strictureplasty, or appendectomy), and 19 (2%) underwent a first non-bowel surgery (abscess drainage or fistulotomy). The cumulative risks for bowel surgery, non-bowel surgery, and all CD-related surgeries were 3.4%, 1.4%, and 4.8%, respectively, at 1 year after diagnosis and 13.8%, 4.5%, and 17.7%, respectively, at 5 years after diagnosis. Older age at diagnosis, greater disease severity, and stricturing or penetrating disease increased the risk of bowel surgery. Disease between the transverse colon and rectum decreased the risk. Initiation of immunomodulator therapy within 30 days of diagnosis, sex, race, and family history of inflammatory bowel disease did not influence the risk of bowel surgery. Conclusions In an analysis of pediatric patients with CD, the 5-year cumulative risk of bowel surgery was lower than that reported in recent studies of adult and pediatric patients but similar to that of a recent retrospective pediatric study. Initiation of immunomodulator therapy at diagnosis did not alter the risk of surgery within 5 years of diagnosis. |
| Databáze: | OpenAIRE |
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