title: Perianal Pediatric Crohn Disease Is Associated With a Distinct Phenotype and Greater Inflammatory Burden.
abstract: Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults.
  
  
  
  Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months.
  
  
  
  Of the 234 included patients (mean age 14.2 ± 2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ± 0.7 vs 4.5 ± 0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings.
  
  
  
  Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.
authors.affiliation: *Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Hospital, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel †Department of Radiology, Sheba Medical Center, Tel-Hashomer, Israel ‡Department of Diagnostic Imaging, Hospital for Sick Children §Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada ||Pediatric Radiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel ¶Department of Radiology, Hospital Regional Universitario Carlos Haya, Malaga, Spain #Electroradiology Department, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Cracow, Poland **Department of Radiology, University of Munich, Munich, Germany ††Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA ‡‡Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH §§Department of Radiology, Connecticut Children's Medical Center, Hartford, CT ||||Department of Radiology, Schneider Children's Hospital, Petah Tikva, Israel ¶¶Diagnostic Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel ##Division of Gastroenterology, Hospital for Sick Children, Toronto, Ontario, Canada ***Institute of Gastroenterology, Nutrition and Liver Disease, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Assa
authors.forename: Michal
authors.initials: M
authors.lastname: Amitai
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: Greer
authors.forename: Denise A
authors.initials: DA
authors.lastname: Castro
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Kuint
authors.forename: Maria
authors.initials: M
authors.lastname: Martínez-León
authors.forename: Izabela
authors.initials: I
authors.lastname: Herman-Sucharska
authors.forename: Eva
authors.initials: E
authors.lastname: Coppenrath
authors.forename: Sudha
authors.initials: S
authors.lastname: Anupindi
authors.forename: Alexander
authors.initials: A
authors.lastname: Towbin
authors.forename: Douglas
authors.initials: D
authors.lastname: Moote
authors.forename: Osnat
authors.initials: O
authors.lastname: Konen
authors.forename: Li-Tal
authors.initials: LT
authors.lastname: Pratt
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D010641:Phenotype; D011379:Prognosis; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D012720:Severity of Illness Index