Objectives: Crohn's disease (CD) behavior and location may change over time, affecting therapeutic decisions. Our aim was to investigate disease phenotypic evolution in pediatric onset Crohn's disease over a prolonged follow-up.
Methods: Records of 105 pediatric onset CD patients with at least 10 years follow-up were reviewed retrospectively. Behavior and location according to accepted pediatric classification were determined at diagnosis and at the end of follow up.
Results: Mean age at diagnosis was 12.5±3.1 years and the median follow-up period was 13.5 years (range, 10-21.5 years). The proportions of disease location at diagnosis and at the end of follow-up were, respectively: ileal in 53 (50.5%) and 44 (41.9%), colonic in 13 (12.4%) and 10 (9.5%), ileocolonic in 35 (33.3%) and 47 (44.8%), isolated upper gastrointestinal involvement in 4 (3.8%) and 2 (1.9%). Overall, 58.1% of patients had a change in disease location. This percentage includes change of the location from colonic or ileal to ileocolonic and vice versa. Proportions of disease behavior at diagnosis and at the end of follow-up were, respectively: non-stricturing non-penetrating in 84 (80%) and 51 (48.6%), stricturing in 17 (16.2%) and 28 (26.7%), penetrating in 4 (3.8%) and 26 (24.8%). Overall, there was an increase of 31.5% in complicated disease behavior over time Perianal involvement increased from 18.1% of cases at presentation to 30.5% at the end of follow-up.
Conclusion: Long-term follow-up of pediatric onset CD demonstrated a substantial change in both disease location and behavior over time.
