title: Natural history of Crohn's disease: comparison between childhood- and adult-onset disease.
abstract: BACKGROUND
  Childhood-onset Crohn's disease (CD) might reflect a more severe form of disease. To test this hypothesis we analyzed the long-term natural history of CD in an adult cohort of patients with childhood-onset compared to adult-onset CD.
  
  
  METHODS
  We selected 206 childhood-onset CD patients among 2992 adult patients with a diagnosis of CD established before December 31, 2000. Disease characteristics were prospectively assessed during follow-up until December 2007 and compared to adult-onset CD patients matched 2 to 1 on gender, year of CD diagnosis, and disease location.
  
  
  RESULTS
  Compared to adult-onset CD, patients with childhood-onset CD were more likely to have a severe disease, with an increased year-by-year disease activity index (37% of patient-years in childhood-onset group versus 31% in the adult-onset group, P < 0.001). Immunosuppressant requirement was also increased with a 10-year cumulative risk of 54 +/- 3% in childhood-onset CD group versus 45 +/- 2%, in the adult-onset CD group (P < 0.001). Cumulative risks of stricturing and penetrating complications and surgical resections were not statistically different between groups. Accordingly, these events occurred at a younger age in the childhood-onset CD group. At the age of 30 years the actuarial risk of having undergone an extensive intestinal resection was 48 +/- 5% in the childhood-onset group versus 14 +/- 2% in the adult-onset group (P < 0.001).
  
  
  CONCLUSIONS
  Patients with childhood-onset CD exhibit a more active disease and require more immunosuppressive therapy. This feature is observed irrespective of the disease location, suggesting an intrinsic more severe phenotype.
authors.affiliation: Gastroentérologie et Nutrition Pédiatrique, Hôpital d'enfants Armand Trousseau, AP-HP, Paris, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Pigneur
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.forename: Sheila
authors.initials: S
authors.lastname: Viola
authors.forename: Jérôme
authors.initials: J
authors.lastname: Viala
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Girardet
authors.forename: Frank M
authors.initials: FM
authors.lastname: Ruemmele
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents