title: The natural history of Crohn's disease in children: a review of population-based studies.
abstract: The incidence of Crohn's disease (CD) has been reported to increase. The aim of this review is to perform a comprehensive literature search of population-based studies focused on the natural history of paediatric-onset CD. A literature search of English and non-English language publications listed in the electronic database of MEDLINE (source PUBMED) and EMBASE from 1935 to 2016 was performed. Population-based studies or national cohorts reporting data on the short-term or long-term disease course of paediatric CD were included. Forty-nine paediatric and 15 nonpaediatric studies on CD have been identified. Up to one-third of children with inflammatory behaviour developed bowel complications more than 5 years after diagnosis. From 48 to 88% of children have experienced at least one corticosteroid course irrespective of the period of diagnosis and up to one-third became steroid dependent. Immunosuppressive preparations were used earlier and more frequently in newer than older cohorts (68 vs. 32% at 5 years) and more than one-third of children have received biological treatment early in the disease course. A decline in the surgery rate might be observed in more recent compared with older unselected populations. The relative risk of cancer in childhood-onset CD as well as the risk of death seem to have increased. Childhood-onset CD seems to be an aggressive phenotype of the disease. Compared with older cohorts, a trend towards decreasing surgical rate can be observed in newer cohorts paralleled by an increase in immunomodulator use and biologicals. Nevertheless, the causative role has yet to be investigated.
authors.affiliation: aIBD Clinical and Research Centre, ISCARE bInstitute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic cEPICOM, European Crohn & Colitis Organisation dGastroenterology Unit, EPIMAD Registry, Amiens University Hospital, University of Picardie Jules Verne, Amiens eGastroenterology Unit, Inserm U954, Nancy University and Hospital, Nancy fPublic Health, Epidemiology and Economic Health, EPIMAD Registry, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional gLille Inflammation Research International Center LIRIC - UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe IBD and Environmental factors: Epidemiology and Functional Analyses, Lille University, Lille, France hDepartment of Emergency, Unit of Gastroenterology, AOU Careggi, Florence, Italy iFirst Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Dana
authors.initials: D
authors.lastname: Duricova
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lakatos
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: Corinne
authors.initials: C
authors.lastname: Gower-Rousseau
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D010641:Phenotype; D012306:Risk
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D007155:Immunologic Factors; D007166:Immunosuppressive Agents