title: Disease course and efficacy of medical therapy in stricturing paediatric Crohn's disease.
abstract: BACKGROUND
  Stricturing is the most common complicated phenotype in paediatric Crohn's disease, but only few studies have described its course, while data on the outcome of medical treatment are scanty.
  
  
  OBJECTIVE
  To retrospectively describes the course of paediatric stricturing Crohn's disease and assess clinical and imaging response to medical therapy.
  
  
  METHODS
  Thirty-six patients with stricturing Crohn's disease were identified by our department database. Paediatric Crohn's disease activity index, need of surgery and magnetic resonance were evaluated as outcomes at 6, 12, 18 and 24 months after detection of stenosis.
  
  
  RESULTS
  Strictures were ileal, ileocolonic and colonic in 61%, 28% and 11% of patients. Thirteen (36%) had stricturing disease at the diagnosis of Crohn's disease, while 64% developed it at the follow-up. At baseline, 89% had medical treatment, while 11% surgery. At 6, 12, 18, and 24 months, 53%, 50%, 42%, and 35% had complete response to medical treatment, respectively. Overall, 44% were unresponsive to medical therapy and required surgery at the follow-up. Responders and non-responders significantly differed for inflammatory imaging findings at the stenosis detection.
  
  
  CONCLUSIONS
  A stricturing phenotype is not uncommon at the diagnosis of Crohn's disease in children. Medical therapy seems poorly effective in avoiding intestinal resection. Magnetic resonance imaging is valuable in identifying patients who will benefit from medical therapy.
authors: Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy.
authors: Marina
authors: M
authors: Aloi
authors: Franca
authors: F
authors: Viola
authors: Giulia
authors: G
authors: D'Arcangelo
authors: Giovanni
authors: G
authors: Di Nardo
authors: Fortunata
authors: F
authors: Civitelli
authors: Emanuele
authors: E
authors: Casciani
authors: Salvatore
authors: S
authors: Oliva
authors: Federica
authors: F
authors: Nuti
authors: Anna
authors: A
authors: Dilillo
authors: Salvatore
authors: S
authors: Cucchiara
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis* / Q000628:therapy*; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000628:therapy*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids