Incidence of stricturing and penetrating complications of Crohn's disease diagnosed in pediatric patients.
BACKGROUND
The development of disease complications is poorly characterized in pediatric patients with Crohn's disease (CD).


METHODS
We retrospectively determined the cumulative incidence of stricturing and penetrating complications of CD prior to first surgery utilizing data from 989 consecutively enrolled CD patients (age 0-17 years at diagnosis) collected between January 2000 and November 2003 and stored in the Pediatric IBD Consortium Registry.


RESULTS
Mean age at diagnosis was 11.5 +/- 3.8 (standard deviation) years. Median follow-up time was 2.8 years. Prior to first surgery, the cumulative incidence of stricturing or penetrating complications was 27% at 5 years and 38% at 10 years from the diagnosis of inflammatory bowel disease. The cumulative incidence of complicated disease was lowest in isolated colonic disease (P = 0.009). Penetrating complications that followed stricturing complications prior to first surgery occurred within 2 years of stricturing complications (cumulative incidence was 13% at 2 years from diagnosis of stricturing disease). Stricturing complications that followed penetrating complications prior to first surgery occurred within 8 years of penetrating complications (cumulative incidence was 26% at 8 years from diagnosis of penetrating complications).


CONCLUSIONS
Strictures, abscesses, and fistulas are common in pediatric CD. Earlier aggressive management may be indicated. Prospective study is required to identify genetic and serologic markers that predict a patient's risk for the development of complicated disease and to determine optimal treatment regimens.
Gupta
Neera
N
UCSF Children's Hospital, University of California, San Francisco, California, USA. ng719@yahoo.com
Bostrom
Alan G
AG
Kirschner
Barbara S
BS
Ferry
George D
GD
Gold
Benjamin D
BD
Cohen
Stanley A
SA
Winter
Harland S
HS
Baldassano
Robert N
RN
Abramson
Oren
O
Smith
Terry
T
Heyman
Melvin B
MB
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007412:Intestinal Fistula / Q000209:etiology; D007413:Intestinal Mucosa / Q000473:pathology*; D007415:Intestinal Obstruction; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate