Fumery Mathurin, Savoye Guillaume, Sarter Hélène, Dupont-Lucas Claire, Bertrand Valérie, Wils Pauline, Richard Nicolas, Guillon Nathalie, Gower-Rousseau Corinne, Turck Dominique, Ley Delphine, Leroyer Ariane
Gastroenterology Unit, Amiens University Hospital, and PeriTox, Université de Picardie Jules Verne, Amiens, France.
Department of Gastroenterology, Univ Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and microbiota-gut-brain axis," CHU Rouen, F-76000 Rouen, France.
Inflamm Bowel Dis. 2025 Jun 25. doi: 10.1093/ibd/izaf133.
Crohn's disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset inflammatory bowel disease (IBD).
All children (<17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were included. The presentation at diagnosis, the risks of complications, surgery, hospitalization, and exposure to different treatments in ileal CD (CD-L1), colonic CD (CD-L2), and UC were compared.
A total of 215 CD-L1 patients, 234 CD-L2 patients, and 337 UC patients were included. Over the study period, the annual incidence rates of CD-L1, CD-L2, and UC were 0.65 (95% CI, 0.57-0.74), 0.71 (0.62-0.81), and 1.02 (0.92-1.14) per 105 persons, respectively. At diagnosis, the proportion of males (L1 53%; L2 53%; UC 43%; P = .012), age at diagnosis (15.0; 13.7; 14.0 years; P = .003), family history of IBD (13%; 11%; 5%; P = .005), diagnostic delay (3.0; 3.0; 2.0 months; P = .001), and smoking prevalence (12%; 8%; 6%; P = .041) were different between the 3 groups. Bloody stools at diagnosis were observed in 15%, 44%, and 91% for, respectively, CD-L1, CD-L2, and UC (P < .001), and diarrhea in 47%, 72%, and 65% (P < .001). At diagnosis, the presence of granuloma was identified in 13% of CD-L1 patients and 31% of CD-L2 patients (P < .001). The risk of extension to L3 was significantly higher in the CD-L2 group than in the CD-L1 group (at 5 years-37% vs. 14%, P < .001). L2 location was associated with a lower risk of luminal fistula (hazard ratio [HR] 0.4 [0.2-0.6], P < .001) but was associated with a higher risk of anoperianal lesion (HR 2.1 [1.3-3.4], P = .003). The prevalence of extraintestinal manifestations, articular (P < .001) and cutaneous (P < .001), was higher in CD-L2. While the 5-year risk of surgery was significantly higher in case of CD-L1 (37%, 13%, and 13%; P < .001), the 5-year exposure to corticosteroids (55%, 69%, and 67%; P < .001), immunosuppressants (47%, 61%, and 42%; p < .001), and anti-TNF (16%, 35%, and 21%; P < .001) were higher in case of L2 location.
The clinical presentation and evolution of ileal and colonic CD differ significantly in children. Colonic location is associated with a high risk of perianal CD, extraintestinal manifestations, and exposure to steroids, immunosuppressants, and anti-TNFs. These differences could justify different therapeutic approaches.
克罗恩病（CD）的病变部位会影响并发症风险和治疗策略。本研究的目的是比较儿童期起病的炎症性肠病（IBD）中结肠CD与回肠CD及溃疡性结肠炎（UC）在诊断时的临床表现和自然病程。
纳入1988年至2011年在一项基于人群的登记研究中诊断为CD或UC的所有儿童（<17岁）。比较回肠CD（CD-L1）、结肠CD（CD-L2）和UC在诊断时的表现、并发症风险、手术、住院情况以及接受不同治疗的情况。
共纳入215例CD-L1患者、234例CD-L2患者和337例UC患者。在研究期间，CD-L1、CD-L2和UC的年发病率分别为每10万人0.65（95%可信区间，0.57 - 0.74）、0.71（0.62 - 0.81）和1.02（0.92 - 1.14）。诊断时，男性比例（L1为53%；L2为53%；UC为43%；P = 0.012）、诊断年龄（15.0岁；13.7岁；14.0岁；P = 0.003）、IBD家族史（13%；11%；5%；P = 0.005）、诊断延迟（3.0个月；3.0个月；2.0个月；P = 0.001）以及吸烟率（12%；8%；6%；P = 0.041）在三组之间存在差异。CD-L1、CD-L2和UC诊断时便血的比例分别为15%、44%和91%（P < 0.001），腹泻的比例分别为47%、72%和65%（P < 0.001）。诊断时，13%的CD-L1患者和31%的CD-L2患者存在肉芽肿（P < 0.001）。CD-L2组向L3扩展的风险显著高于CD-L1组（5年时分别为37%和14%，P < 0.001）。L2病变部位与肠腔瘘风险较低相关（风险比[HR] 0.4 [0.2 - 0.6]，P < 0.001），但与肛门周围病变风险较高相关（HR 2.1 [1.3 - 3.4]，P = 0.003）。CD-L2患者肠外表现、关节（P < 0.001）和皮肤（P < 0.001）表现的患病率较高。虽然CD-L1患者5年手术风险显著更高（分别为37%、13%和13%；P < 0.001），但L2病变部位患者5年使用皮质类固醇（分别为55%、69%和67%；P < 0.001）、免疫抑制剂（分别为47%、61%和42%；P < 0.001）和抗TNF药物（分别为16%、35%和21%；P < 0.001）的比例更高。
儿童回肠和结肠CD的临床表现及病程有显著差异。结肠病变部位与肛周CD、肠外表现以及使用类固醇、免疫抑制剂和抗TNF药物的风险较高相关。这些差异可能为不同的治疗方法提供依据。
