title: Evolution of disease phenotype in pediatric-onset Crohn's disease after more than 10 years follow up-Cohort study.
abstract: BACKGROUND
  Pediatric-onset Crohn's disease (CD) is a heterogeneous disorder which is subjected to progression and complications in a substantial proportion of patients.
  
  
  OBJECTIVE
  We aimed to assess the progression in pediatric-onset CD phenotype on long term follow up.
  
  
  METHODS
  Medical charts of pediatric onset CD patients with at least 10 years follow-up were analyzed retrospectively. Disease phenotype was determined at diagnosis and during follow up at different time points. Phenotype was determined according to the Paris classification. The impact of possible predictors on phenotype progression was assessed as well as the association between different therapeutic regimens during disease course and phenotype progression.
  
  
  RESULTS
  Progression of disease location, behavior, and perianal involvement was observed in 20%, 38% and 20% of patients, respectively, after a median follow-up of 16.4 (±4.4) years. Microscopic ileocolonic disease at diagnosis was significant predictors for progression of disease extent. Treatment with anti tumor necrosis factor-ɑ agents and number of flares per years of follow-up were associated with progression of disease extent, behavior and perianal involvement.
  
  
  CONCLUSIONS
  Disease extent, behavior and prevalence of perianal disease change significantly over time in pediatric-onset CD. In our cohort, most clinical, laboratory and endoscopic parameters do not serve as predictors for long-term disease progression.
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel. Electronic address: firasytr@gmail.com.
authors.forename: Firas
authors.initials: F
authors.lastname: Rinawi
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Assa
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Corina
authors.initials: C
authors.lastname: Hartman
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Mozer Glassberg
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel.
authors.forename: Vered
authors.initials: V
authors.lastname: Nachmias Friedler
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Rosenbach
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel.
authors.forename: Ari
authors.initials: A
authors.lastname: Silbermintz
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Zevit
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D010641:Phenotype; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D054328:Proton Pump Inhibitors
keywords: Crohn’s disease; Long-term follow-up; Phenotype progression