title: Long-term outcome after first intestinal resection in pediatric-onset Crohn's disease: a population-based study.
abstract: BACKGROUND
  To describe long-term postoperative evolution of pediatric-onset Crohn's disease (CD) and identify predictors of outcome we studied a population-based cohort (1988-2004) of 404 patients (0-17 years), of which 130 underwent surgery.
  
  
  METHODS
  Risks for a second resection and first need for immunosuppressors (IS) and/or biologics were estimated by survival analysis and Cox models used to determine predictors of outcome. Impact of time of first surgery on nutritional catch-up was studied using regression.
  
  
  RESULTS
  In all, 130 patients (70 females) with a median age at diagnosis of 14.2 years (interquartile range: 12-16) were followed for 13 years (9.4-16.6). Probability of a second resection was 8%, 17%, and 29% at 2, 5, and 10 years, respectively. In multivariate analysis, age <14, stenosing (B2) and penetrating (B3) behaviors and upper gastrointestinal location (L4) at diagnosis were associated with an increased risk of second resection. Probability of receiving IS or biologics was 18%, 34%, and 47% at 2, 5, and 10 years, respectively. In multivariate analysis, L4 was a risk factor for requiring IS or biologics, while surgery within 3 years after CD diagnosis was protective. Catch-up in height and weight was better in patients who underwent surgery within 3 years after CD diagnosis than those operated on later.
  
  
  CONCLUSIONS
  In this pediatric-onset CD study, mostly performed in a prebiologic era, a first surgery performed within 3 years after CD diagnosis was associated with a reduced need for IS and biologics and a better catch-up in height and weight compared to later surgery.
authors.affiliation: Univ Lille Nord de France, CHU Lille and Lille-2 University, Gastroenterology Unit, France.
authors.forename: Médina
authors.initials: M
authors.lastname: Boualit
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.forename: Dominique
authors.initials: D
authors.lastname: Turck
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savoye
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Dupas
authors.forename: Eric
authors.initials: E
authors.lastname: Lerebours
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Véronique
authors.initials: V
authors.lastname: Merle
authors.forename: Antoine
authors.initials: A
authors.lastname: Cortot
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: Corinne
authors.initials: C
authors.lastname: Gower-Rousseau
mesh_terms: D000293:Adolescent; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome