*Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Hospital, Petach-Tikva, Israel; and †Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Inflamm Bowel Dis. 2017 Sep;23(9):1659-1665. doi: 10.1097/MIB.0000000000001171.
Data on the outcomes of children with perianal Crohn's disease are limited. We aimed to assess phenotypic features at diagnosis and long-term disease-specific outcomes of this phenotype.
The medical records of 296 pediatric onset patients with Crohn's disease, diagnosed from 2001 to 2015, were reviewed retrospectively. Baseline characteristics included age, sex, severity indices, laboratory data, endoscopic findings, and anthropometric measurements. Main outcome measures included time to first flare, hospitalization, surgery, and biological therapy.
Of the 296 included patients (median age 14.2 years), 70 (24%) had nonfistulizing perianal findings, whereas only 40 (13%) had fistulizing perianal disease at diagnosis. Perianal involvement was associated with female sex (P = 0.01), whereas fistulizing perianal disease resulted in a greater use of immunomodulators (P = 0.01). Time to hospitalization was shorter for both nonfistulizing and fistulizing perianal disease (hazard ratio [HR] 1.66 and 1.34, respectively, P = 0.027) and time to biological therapy (HR 2.1 and 1.7, respectively, P = 0.002). There were no differences in time to first flare or surgery. During a median follow-up of 8.5 years, additional 26 patients (10%) developed fistulizing perianal disease after a median time of 3.5 years. The presence of nonfistulizing disease at diagnosis was a significant risk factor for the development of fistulizing perianal disease (HR 3.4, P = 0.002). At the end of follow-up, complicated disease was more common in patients with any perianal involvement (P = 0.01).
Pediatric patients with Crohn's disease with both nonfistulizing and fistulizing disease have worse clinical outcomes. Nonfistulizing disease is a risk factor for the development of fistulizing disease over time.
有关肛周克罗恩病患儿结局的数据有限。我们旨在评估该表型的诊断时表型特征和长期疾病特异性结局。
回顾性分析了 2001 年至 2015 年期间诊断的 296 例儿童发病的克罗恩病患者的病历。基线特征包括年龄、性别、严重程度指数、实验室数据、内镜发现和人体测量值。主要观察指标包括首次发作、住院、手术和生物治疗的时间。
在 296 例纳入的患者中（中位年龄 14.2 岁），70 例（24%）存在非瘘管性肛周病变，而仅有 40 例（13%）在诊断时存在瘘管性肛周疾病。肛周受累与女性性别相关（P=0.01），而瘘管性肛周疾病则导致更多地使用免疫调节剂（P=0.01）。非瘘管性和瘘管性肛周疾病的住院时间均较短（风险比[HR]分别为 1.66 和 1.34，P=0.027），生物治疗时间也较短（HR 分别为 2.1 和 1.7，P=0.002）。首次发作或手术时间无差异。在中位随访 8.5 年期间，另外 26 例患者（10%）在中位时间 3.5 年后发展为瘘管性肛周疾病。诊断时存在非瘘管性疾病是发展为瘘管性肛周疾病的显著危险因素（HR 3.4，P=0.002）。在随访结束时，任何肛周受累的患者更常见复杂疾病（P=0.01）。
患有克罗恩病的儿科患者，无论是否存在非瘘管性或瘘管性疾病，其临床结局均较差。非瘘管性疾病是随着时间的推移发展为瘘管性疾病的危险因素。
