[Over one year follow-up report for newly diagnosed pediatric Crohn's disease].
OBJECTIVE
To explore the clinical characteristics, therapeutic responses and outcomes of pediatric Crohn's disease (CD).


METHODS
From a hospital-derived incidence cohort, 20 Crohn's disease patients (aged 0.5 - 15 years old at diagnosis), diagnosed from 2003 to 2009, received a follow-up period of more than one year. The patients were phenotyped according to Montreal standards. PCDAI was introduced to assess the disease activity and the Hyams J rules adopted to evaluate the therapeutic efficacies. The treatment was individualized based on the overall evaluation of child.


RESULTS
Of these 20 patients, 55% were 7 - 12 years old at the diagnosis time. The male: female ratio was 1.5:1. At the time of diagnosis, the common manifestations included abdominal pain (95.0%), fever (80.0%) and diarrhea (80.0%). Growth retardation was detected in 50% of the cases. Complicated behavior was observed in 45% patients at diagnosis. The most frequent disease location at diagnosis was terminal ileum/colon (55%). Upper GI tract involvement was quite common in children (20%). Non-penetrating non-stricture (50%) behavior was most frequent at diagnosis. Ultimately, corticosteroids plus 6-MP/AZA treatment was administrated in 11 cases. Of these, 9 (82%) successfully withdrew the corticosteroids and maintained a complete remission. Colonoscopy was repeated in 6 complete remission cases and 4 of them achieved a complete mucosa healing. The mean follow-up period was 23 months (range: 12 - 59). At the endpoint of follow-up, 15 cases achieved a complete remission, 4 had a partial remission, 1 underwent operation and none of them died. The children who successfully withdrew from corticosteroids and achieved a complete remission could catch up the height of their age group. 6-MP/AZA associated severe adverse effects were reported at 17% in this group.


CONCLUSIONS
Growth retardation is predominant in pediatric CD and it may provide diagnostic clues. Immunosuppressant therapy may improve the natural history of this disease. It is safe under close monitoring.
Gao
Xiang
X
Department of Gastroenterology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Shen
Zhen-yu
ZY
Chen
Min-hu
MH
Xiao
Ying-lian
YL
Yang
Rong-ping
RP
Hu
Pin-jin
PJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male