Aim: Our aim was to describe the characteristics of children with crohn`s disease (CD) and to assess the rate of surgical interventions during a long-term follow up period from Schneider Pediatric Inflammatory Bowel Disease (SPID) cohort which was recently established.
Methods: We performed a chart review using the (SPID) cohort database, including pediatric CD patients.
Results: 705 children diagnosed with IBD between 1981 and 2013 were included, 479 (68%) of whom were diagnosed with CD. Mean age at diagnosis was 13.4 y (range 2-18y). Among 479 patients with CD, 147 (31%) underwent a surgical procedure. Median interval from diagnosis to first intervention was 5.5 yr (range 0.42-26.2 yr). At diagnosis, 44% (211/479) patients presented with ileal disease , 17% (81/479) with isolated colonic disease , 36% (173/479) with ileo-colonic disease. Among patients who presented with ileal disease, 43% (90/211) underwent surgical intervention, compared to 25% (44/173) and 16% (13/81) of ileo-colonic and colonic disease respectively (p<0.001). Complicated disease behavior (defined as stricturing, penetrating or both) was observed in 24% (115/479) at diagnosis. Among these patients 45% (52/115) underwent surgical intervention compared to 26% (95/364) for those with uncomplicated disease (p<0.001) .Ten-year surgical intervention rate was 31% (58/187) prior to the year 2000 and 19% (55/292) afterwards (p=0.002).
Conclusion: Ileal disease phenotype and complicated behavior at presentation predicted a higher rate of surgical interventions during follow-up. We observed a significant decrease in surgical intervention rate in recent years which could be attributed to the emergence of biologic therapies.
