Long-Term Follow-Up and Predictors of Complicated Disease Behavior in Pediatric Crohn`s Disease Patients

Objective: To describe the long-term outcome of Pediatric Crohn`s Disease (CD) patients and identify risk factors for complicated disease behavior.

Methods: Patients diagnosed between 1998 –2014, under 18.6y were included. Baseline data: age, gender, weight, height, BMI percentiles and family history of IBD (inflammatory Bowel Disease). Disease characteristics (Paris classification), laboratory testing, imaging and treatment. Outcome data included current age, years since diagnosis, treatment, relapses and evidence of stricturing or penetrating disease, hospitalizations, surgery, malignancy, co-morbidities and mortality.

Results: 93 patients were included, mean age 13.5 y (+/-3.2 SD), 51 (54.8%) male, median follow of 10.3 y (+/-4.1 SD (, 30 (32.3%) had a relative with IBD. Location at diagnosis: 29 (31.2%) ileal, 17 (18.3%) colonic, 40 (43.0%) ileo-colonic. Seven (7.5%) had upper intestinal and 36 (38.7%) perianal involvement. Behavior at diagnosis, 68 (73.1%) inflammatory (B1) and 25 (26.9%) with complicated behavior [(B2 (stricturing) and/or B3 (penetrating)]. At the end of follow-up: 20 (23.2%) of B1 evolved to B2 and/or B3, thus 45 (48.4%) had complicated behavior. During follow-up 67 (72%) were hospitalized, 20 underwent surgery, two developed cancer, with no mortalities. In a multivariate cox model, growth delay (HR, 5.02 [1.10-22.85], p=0.037) and low albumin levels (HR, 3.97 [1.32- 11.97], p=0.014) at diagnosis were predictors of complicated disease in adulthood.

Conclusions: Over a quarter of pediatric CD patients present with complicated disease. During follow-up, another 25% progress to complicated disease and 20% require surgery. Delayed growth and low albumin at diagnosis were predictors of complicated disease.