Factors that determine risk for surgery in pediatric patients with Crohn's disease.
OBJECTIVE
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.
Schaefer
Marc E
ME
Pediatric Inflammatory Bowel Disease Collaborative Research Group, Hartford, Connecticut, USA.
Machan
Jason T
JT
Kawatu
David
D
Langton
Christine R
CR
Markowitz
James
J
Crandall
Wallace
W
Mack
David R
DR
Evans
Jonathan S
JS
Pfefferkorn
Marian D
MD
Griffiths
Anne M
AM
Otley
Anthony R
AR
Bousvaros
Athos
A
Kugathasan
Subra
S
Rosh
Joel R
JR
Keljo
David J
DJ
Carvalho
Ryan S
RS
Tomer
Gitit
G
Mamula
Petar
P
Kay
Marsha H
MH
Kerzner
Benny
B
Oliva-Hemker
Maria
M
Kappelman
Michael D
MD
Saeed
Shehzad A
SA
Hyams
Jeffrey S
JS
Leleiko
Neal S
NS
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018570:Risk Assessment
D007155:Immunologic Factors