title: Evolution of disease phenotype in adult and pediatric onset Crohn's disease in a population-based cohort.
abstract: OBJECTIVE
  To investigate the evolution of disease phenotype in adult and pediatric onset Crohn's disease (CD) populations, diagnosed between 1977 and 2008.
  
  
  METHODS
  Data of 506 incident CD patients were analyzed (age at diagnosis: 28.5 years, interquartile range: 22-38 years). Both in- and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008 in adult and pediatric onset CD populations. Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis.
  
  
  RESULTS
  Among this population-based cohort, seventy-four (12.8%) pediatric-onset CD patients were identified (diagnosed ≤ 17 years of age). There was no significant difference in the distribution of disease behavior between pediatric (B1: 62%, B2: 15%, B3: 23%) and adult-onset CD patients (B1: 56%, B2: 21%, B3: 23%) at diagnosis, or during follow-up. Overall, the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5- and 10-years of follow-up. Similarly, time to change in disease behaviour from non stricturing, non penetrating (B1) to complicated, stricturing or penetrating (B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis. Calendar year of diagnosis (P = 0.04), ileal location (P < 0.001), perianal disease (P < 0.001), smoking (P = 0.038) and need for steroids (P < 0.001) were associated with presence of, or progression to, complicated disease behavior at diagnosis and during follow-up. A change in disease location was observed in 8.9% of patients and it was associated with smoking status (P = 0.01), but not with age at diagnosis.
  
  
  CONCLUSIONS
  Long-term evolution of disease behavior was not different in pediatric- and adult-onset CD patients in this population-based cohort but was associated to location, perianal disease and smoking status.
authors.affiliation: First Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Barbara Dorottya
authors.initials: BD
authors.lastname: Lovasz
authors.forename: Laszlo
authors.initials: L
authors.lastname: Lakatos
authors.forename: Agnes
authors.initials: A
authors.lastname: Horvath
authors.forename: Istvan
authors.initials: I
authors.lastname: Szita
authors.forename: Tunde
authors.initials: T
authors.lastname: Pandur
authors.forename: Michael
authors.initials: M
authors.lastname: Mandel
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Vegh
authors.forename: Petra Anna
authors.initials: PA
authors.lastname: Golovics
authors.forename: Gabor
authors.initials: G
authors.lastname: Mester
authors.forename: Mihaly
authors.initials: M
authors.lastname: Balogh
authors.forename: Csaba
authors.initials: C
authors.lastname: Molnar
authors.forename: Erzsebet
authors.initials: E
authors.lastname: Komaromi
authors.forename: Lajos Sandor
authors.initials: LS
authors.lastname: Kiss
authors.forename: Peter Laszlo
authors.initials: PL
authors.lastname: Lakatos
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010641:Phenotype; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Age at diagnosis; Crohn’s disease; Disease behavior; Disease course