title: Presentation and disease course in early- compared to later-onset pediatric Crohn's disease.
abstract: BACKGROUND
  The relationship between the age at diagnosis and disease course is poorly defined in children with Crohn's disease (CD). We examined the presentation and course of disease in patients 0-5 compared to 6-17 yr of age at diagnosis.
  
  
  METHODS
  We analyzed uniform data from 989 consecutive CD patients collected between January 2000 and November 2003, and stored in the Pediatric IBD Consortium Registry. The statistical tests account for the length of follow-up of each patient.
  
  
  RESULTS
  In total, 98 patients (9.9%) were of 0-5 yr of age at diagnosis. The mean follow-up time was 5.6 +/- 5.0 yr in the younger group and 3.3 +/- 2.8 yr in the older group (P < 0.001). Race/ethnicity differed by the age group (P= 0.015); a larger proportion of the younger group was Asian/Pacific Islander or Hispanic, and a larger proportion of the older group was African American. The initial classification as ulcerative colitis or indeterminate colitis was more common among the 0-5 yr of age group (P < 0.001). The 6-17 yr of age patients presented with more abdominal pain (P < 0.001), weight loss (P= 0.001), or fever (P= 0.07), while the 0-5 yr of age patients presented with more rectal bleeding (P= 0.008). The 6-17 yr of age patients were more likely to be treated with antibiotics (P < 0.001), 6-mercaptopurine/azathioprine (P < 0.001), infliximab (P= 0.001), or corticosteroids (P= 0.0006). The 6-17 yr of age patients had a higher cumulative incidence of treatment with 5-aminosalicylates (P= 0.009) or methotrexate (P= 0.04). The risk for developing an abscess (P= 0.001), a fistula (P= 0.02), a stricture (P= 0.05), or a perianal fissure (P= 0.06) was greater in the 6-17 yr of age patients.
  
  
  CONCLUSIONS
  The 6-17 yr of age patients with CD appear to have a more complicated disease course compared to 0-5 yr of age children. The 0-5 yr of age group may represent a unique disease phenotype and benefit from different approaches to management. Long-term prospective studies are required to validate these findings.
authors.affiliation: UCSF Children's Hospital, University of California, San Francisco, California 94143-0136, USA.
authors.forename: Neera
authors.initials: N
authors.lastname: Gupta
authors.forename: Alan G
authors.initials: AG
authors.lastname: Bostrom
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Kirschner
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Oren
authors.initials: O
authors.lastname: Abramson
authors.forename: George D
authors.initials: GD
authors.lastname: Ferry
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Gold
authors.forename: Harland S
authors.initials: HS
authors.lastname: Winter
authors.forename: Robert N
authors.initials: RN
authors.lastname: Baldassano
authors.forename: Terry
authors.initials: T
authors.lastname: Smith
authors.forename: Melvin B
authors.initials: MB
authors.lastname: Heyman
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States
references.citation: J Clin Gastroenterol. 2006 Aug;40(7):583-6
references.pmid: 16917397
references.citation: Am J Gastroenterol. 2002 Aug;97(8):2005-10
references.pmid: 12190168
references.citation: Best Pract Res Clin Gastroenterol. 2004 Jun;18(3):509-23
references.pmid: 15157824
references.citation: Gut. 2006 Sep;55(9):1248-54
references.pmid: 16423890
references.citation: J Pediatr. 2005 Jan;146(1):35-40
references.pmid: 15644819
references.citation: Gastroenterology. 2006 Apr;130(4):1069-77
references.pmid: 16618401
references.citation: Pediatrics. 2007 Dec;120(6):e1418-25
references.pmid: 18055660
references.citation: Gastroenterology. 1996 Sep;111(3):580-6
references.pmid: 8780560
references.citation: Gastroenterology. 2006 Mar;130(3):650-6
references.pmid: 16530505
references.citation: J Pediatr Gastroenterol Nutr. 1991 May;12(4):439-47
references.pmid: 1678008
references.citation: Gastroenterology. 2003 Dec;125(6):1583-90
references.pmid: 14724808
references.citation: Arch Dis Child. 2003 Nov;88(11):995-1000
references.pmid: 14612366
references.citation: Indian J Pediatr. 2006 Aug;73(8):717-21
references.pmid: 16936368
references.citation: Arch Intern Med. 1986 Apr;146(4):753-5
references.pmid: 3963958
references.citation: J Clin Gastroenterol. 1998 Sep;27(2):129-33
references.pmid: 9754773
references.citation: Inflamm Bowel Dis. 2006 Jan;12(1):57-61
references.pmid: 16374260
references.citation: Am J Gastroenterol. 1997 Sep;92(9):1467-71
references.pmid: 9317064