Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease
Tal David Berger
Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Search for more papers by this authorHuey Miin Lee
Paediatric Liver, GI & Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
Search for more papers by this authorLavenya Ramasamy Padmanaban
Paediatric Liver, GI & Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
Search for more papers by this authorEytan Wine
Edmonton Pediatric IBD Clinic, University of Alberta, Edmonton, Canada
Search for more papers by this authorAnat Yerushalmy-Feler
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
Search for more papers by this authorIva Hojsak
Children's Hospital Zagreb, University of Zagreb School of Medicine, University of J. J. Strossmayer School of Medicine Osijek, Croatia
Search for more papers by this authorDenis Kazeka
Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
Search for more papers by this authorDaniela Elena Serban
2nd Clinic of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
Search for more papers by this authorDotan Yogev
Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, affiliated to the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Search for more papers by this authorOren Ledder
Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, affiliated to the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Search for more papers by this authorPaolo Lionetti
Department Neurofarba, University of Florence, Meyer Children Hospital, Florence, Italy
Search for more papers by this authorLuca Scarallo
Department Neurofarba, University of Florence, Meyer Children Hospital, Florence, Italy
Search for more papers by this authorMarco Gasparetto
The Royal London Children's Hospital, Barts’ Health NHS Trust, London
Search for more papers by this authorNicholas M. Croft
The Royal London Children's Hospital, Barts’ Health NHS Trust, London
Barts and the London School of Medicine, Queen Mary University of London, London, UK
Search for more papers by this authorErasmo Miele
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Naples, Italy
Search for more papers by this authorAnnamaria Staiano
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Naples, Italy
Search for more papers by this authorJoseph Meredith
Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
Search for more papers by this authorMarina Aloi
Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome
Search for more papers by this authorPatrizia Alvisi
Pediatric Unit, Maggiore Hospital, Bologna, Italy
Search for more papers by this authorDarja Urlep
Department of Gastroenterology Hepatology and Nutrition, Children's Hospital University Medical Centre Ljubljana, Ljubljana, Slovenia
Search for more papers by this authorBatia Weiss
Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Search for more papers by this authorMikkel Malham
The pediatric Department, Copenhagen University Hospital, Hvidovre, The Pediatric Department, Holbaek Hospital, Denmark
Search for more papers by this authorManar Matar
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Search for more papers by this authorVíctor Manuel Navas-López
Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga;, Spain
Search for more papers by this authorClaudio Romano
Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
Search for more papers by this authorValeria Dipasquale
Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
Search for more papers by this authorLorenzo Norsa
Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
Search for more papers by this authorKaija-Leena Kolho
Paediatric Gastroenterology of the Children's Hospital, University of Helsinki, Helsinki, Finland
Search for more papers by this authorRaanan Shamir
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Search for more papers by this authorCorresponding Author
Dror S. Shouval
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Address correspondence and reprint requests to Dror S. Shouval, MD, MMSc, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan st, Petah Tikva 4920235, Israel (e-mail: [email protected]).Search for more papers by this authorPaediatric IBD Porto Group of ESPGHAN
Search for more papers by this authorTal David Berger
Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Search for more papers by this authorHuey Miin Lee
Paediatric Liver, GI & Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
Search for more papers by this authorLavenya Ramasamy Padmanaban
Paediatric Liver, GI & Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
Search for more papers by this authorEytan Wine
Edmonton Pediatric IBD Clinic, University of Alberta, Edmonton, Canada
Search for more papers by this authorAnat Yerushalmy-Feler
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
Search for more papers by this authorIva Hojsak
Children's Hospital Zagreb, University of Zagreb School of Medicine, University of J. J. Strossmayer School of Medicine Osijek, Croatia
Search for more papers by this authorDenis Kazeka
Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
Search for more papers by this authorDaniela Elena Serban
2nd Clinic of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
Search for more papers by this authorDotan Yogev
Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, affiliated to the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Search for more papers by this authorOren Ledder
Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, affiliated to the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Search for more papers by this authorPaolo Lionetti
Department Neurofarba, University of Florence, Meyer Children Hospital, Florence, Italy
Search for more papers by this authorLuca Scarallo
Department Neurofarba, University of Florence, Meyer Children Hospital, Florence, Italy
Search for more papers by this authorMarco Gasparetto
The Royal London Children's Hospital, Barts’ Health NHS Trust, London
Search for more papers by this authorNicholas M. Croft
The Royal London Children's Hospital, Barts’ Health NHS Trust, London
Barts and the London School of Medicine, Queen Mary University of London, London, UK
Search for more papers by this authorErasmo Miele
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Naples, Italy
Search for more papers by this authorAnnamaria Staiano
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Naples, Italy
Search for more papers by this authorJoseph Meredith
Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
Search for more papers by this authorMarina Aloi
Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome
Search for more papers by this authorPatrizia Alvisi
Pediatric Unit, Maggiore Hospital, Bologna, Italy
Search for more papers by this authorDarja Urlep
Department of Gastroenterology Hepatology and Nutrition, Children's Hospital University Medical Centre Ljubljana, Ljubljana, Slovenia
Search for more papers by this authorBatia Weiss
Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Search for more papers by this authorMikkel Malham
The pediatric Department, Copenhagen University Hospital, Hvidovre, The Pediatric Department, Holbaek Hospital, Denmark
Search for more papers by this authorManar Matar
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Search for more papers by this authorVíctor Manuel Navas-López
Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga;, Spain
Search for more papers by this authorClaudio Romano
Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
Search for more papers by this authorValeria Dipasquale
Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
Search for more papers by this authorLorenzo Norsa
Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
Search for more papers by this authorKaija-Leena Kolho
Paediatric Gastroenterology of the Children's Hospital, University of Helsinki, Helsinki, Finland
Search for more papers by this authorRaanan Shamir
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Search for more papers by this authorCorresponding Author
Dror S. Shouval
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Address correspondence and reprint requests to Dror S. Shouval, MD, MMSc, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan st, Petah Tikva 4920235, Israel (e-mail: [email protected]).Search for more papers by this authorPaediatric IBD Porto Group of ESPGHAN
Search for more papers by this authorThe authors report no conflicts of interest.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).
ABSTRACT
Objectives:
Adult studies suggest that patients with isolated colonic Crohn disease (L2 CD) exhibit unique characteristics differentiating them from patients with ileo-caecal (L1) CD and ulcerative colitis (UC). We aimed to characterize clinical features and outcomes of paediatric patients with L2.
Methods:
Retrospective data was collected through the Porto Inflammatory Bowel Disease group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on Paediatric patients with L2, L1 or UC at different time-points. Outcome measures included time to first flare, hospital admissions, initiation of anti-tumor necrosis factor-alpha (TNFα) drug, stricture and surgery.
Results:
Three hundred patients were included: 102 L1, 94 L2 and 104 UC. Rates of hematochezia at presentation were 14.7%, 44.7% and 95.2%, while rates of fever were 12.7%, 26.6% and 2.9%, for patients with L1, L2 and UC, respectively (P < 0.001 for all comparisons). Skip lesions were identified in 65% of patients with L2, and granulomas in 36%, similar to L1 patients. Rates of anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic (pANCA) positivity significantly differed between the three groups: 25.4% and 16.7% for patients with L2, compared with 55.2% and 2.3%, and 1.8% and 52.9% for patients with L1 and UC, respectively. Response rates to exclusive enteral nutrition were comparable between L1 and L2 (78.3–82.4%), as was the response to oral steroids (70.4–76.5%) in the three groups. While times to first flare and admission were similar between groups, patients with L1 were commenced on anti-TNFα earlier. Moreover, stricturing phenotype and need for colectomy were very rare in patients with L2.
Conclusions:
Significant differences are observed in the clinical presentation and outcomes of Paediatric patients with L2, compared to patients with L1 and UC.
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