Pediatric Crohn's disease activity at diagnosis, its influence on pediatrician's prescribing behavior, and clinical outcome 5 years later

• Published in: Inflammatory bowel diseases 2009-11, Vol.15 (11), p.1670-1677
• Main Authors: Mesker, Tamara, van Rheenen, Patrick F., Norbruis, Obbe F., Uitentuis, Jan, Waalkens, Herman J., Gonera, Gieneke, van Overbeek, Lidy A.T., Butler, Joke, Rings, Edmond H.H.M.
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Body Height; Body Weight; Child; Child, Preschool; Crohn Disease - diet therapy; Crohn Disease - drug therapy; Crohn's disease; Enteral Nutrition; Female; Follow-Up Studies; Humans; Immunologic Factors - therapeutic use; Male; Mesalamine - administration & dosage; Mesalamine - adverse effects; outcome; PCDAI; Practice Patterns, Physicians; remission; Remission Induction; Retrospective Studies; Severity of Illness Index; Steroids - therapeutic use; treatment
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.20950

Background: No studies have been performed in which therapeutic regimens have been compared between mild and moderate‐to‐severe pediatric Crohn's disease (CD) at diagnosis. The aim was to analyze pediatric CD activity at diagnosis, its influence on pediatrician's prescribing behavior, and clinical outcome 5 years later. Methods: In a retrospective multicenter study we divided pediatric CD patients at diagnosis into mild or moderate‐severe disease. We compared initial therapies, duration of first remission, number of exacerbations, height‐for‐age and weight‐for‐height evolvement, and cumulative duration of systemic steroid use in a 5‐year follow‐up period. Results: Forty‐three children were included (25 with mild and 18 with moderate‐severe disease). Aminosalicylate monotherapy was more frequently prescribed in the mild group (40% versus 17%; P < 0.01). The median duration of systemic steroid use was 18.3 months in the mild group and 10.4 months in the moderate‐severe group (P = 0.09). Duration of first remission was 15.0 months in the mild group and 23.4 months in the moderate‐severe group (P = 0.16). The mean number of exacerbations was 2.2 in the mild group and 1.8 in the moderate‐severe group (P = 0.28). Conclusions: CD patients with mild disease were treated with aminosalicylate monotherapy more frequently. These patients, however, tend to have more exacerbations, shorter duration of first remission, and longer total duration of systemic steroid use. Our data support the concept that severity of disease at diagnosis does not reliably predict subsequent clinical course. This study suggests that there is no indication that children with mild CD should be treated differently compared to children with moderate‐severe disease. (Inflamm Bowel Dis 2009)