Natural history of Crohn's disease: Comparison between childhood‐and adult‐onset disease (original) (raw)
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Clinical predictors at diagnosis of disabling pediatric Crohnʼs disease
Inflammatory Bowel Diseases, 2012
Background: Identification of children with Crohn's disease (CD) at high risk of disabling disease would be invaluable in guiding initial therapy. Our study aimed to identify predictors at diagnosis of a subsequent disabling course in a population-based cohort of patients with pediatriconset CD.
Journal of Crohn's and Colitis Supplements
CD is still not clear. Therefore, we examined the relationship between the presence of PAB, disease phenotype, anti-Saccharomyces cerevisiae antibodies (ASCA) and NOD2/CARD15 genotype in pediatric Crohn's disease patients. Methods: Forty-nine CD patients (2 18 years, M/F=1.7/1) were tested for PAB by indirect immunofluorescence and for ASCA by enzyme-linked immunosorbent assay. All patients had genotyping performed using sequence specific PCR directed against the wild type and the R702W, G908R and 3020insC variants of NOD2/CARD15 gene. Disease location, disease activity at the time of diagnosis and the presence of complicated disease phenotype (penetrating/stricturing) were determined. Results: 34.7% of CD patients were PAB-positive. ASCA (IgG and/or IgA) were found in 63.2% of the patients. 24.5% of CD patients had at least one of the three principal variants of NOD2/CARD15 gene.There was no significant association between the presence of PAB and the carriage of NOD2/CARD15 variants (p = 0.051) and between PAB and the location of the disease (p = 0.574). A positive association of PAB with ASCA (p = 0.001), disease activity at the time of diagnosis (p = 0.003) and more complicated disease phenotype (p = 0.006) was found. Conclusion: A positive association of PAB with ASCA, higher disease activity at the time of diagnosis and more complicated disease phenotype was observed in our study. This observation suggests PAB may be a useful serologic marker for complicated disease behavior in pediatric CD.
Increased Immune Reactivity Predicts Aggressive Complicating Crohn's Disease in Children
Clinical Gastroenterology and Hepatology, 2008
Background & Aims: The ability to identify children with CD who are at highest risk for rapid progression from uncomplicated to complicated phenotypes would be invaluable in guiding initial therapy. The aims of this study were to determine whether immune responses and/or CARD15 variants are associated with complicated disease phenotypes and predict disease progression. Methods: Sera were collected from 796 pediatric CD cases and tested for anti-Cbir1 (flagellin), anti-outer membrane protein C, anti-Saccharomyces cerevisiae, and perinuclear antineutrophil cytoplasmic antibody by using enzyme-linked immunosorbent assay. Genotyping (Taqman MGB) was performed for 3 CARD15 variants (single nucleotide polymorphisms 8, 12, and 13). Associations between immune responses (antibody sum and quartile sum score, CARD15, and clinical phenotype were evaluated.
Disease Phenotype at Diagnosis in Pediatric Crohnʼs Disease
Inflammatory Bowel Diseases, 2013
Background: It has been speculated that pediatric Crohn's disease (CD) is a distinct disease entity, with probably different disease subtypes. We therefore aimed to accurately phenotype newly diagnosed pediatric CD by using the pediatric modification of the Montreal classification, the Paris classification. Methods: Information was collected from the EUROKIDS registry, a prospective, web-based registry of new-onset pediatric IBD patients in 17 European countries and Israel. When a complete diagnostic workup was performed (ileocolonoscopy, upper gastrointestinal [GI] endoscopy, small bowel imaging), CD patients were evaluated for ileocolonic disease extent, esophagogastroduodenal involvement, and jejunal/proximal ileal involvement. Disease behavior and the occurrence of granulomas were also analyzed. Results: In all, 582 pediatric CD patients could be classified according to the Paris classification. Isolated terminal ileal disease (6limited cecal disease) was seen at presentation in 16%, isolated colonic disease in 27%, ileocolonic disease in 53%, and isolated upper GI disease in 4% of patients. In total, 30% had esophagogastroduodenal involvement and 24% jejunal/proximal ileal disease. Patients with L2 disease were less likely to have esophagogastroduodenal involvement or stricturing disease than patients with L1 or L3 disease. Terminal ileal disease and stricturing disease behavior were more common in children diagnosed after 10 years of age than in younger patients. Granulomas were identified in 43% of patients. Conclusions: Accurate phenotyping is essential in pediatric CD, as this affects the management of individual patients. Disease phenotypes differ according to age at disease onset. The Paris classification is a useful tool to capture the variety of phenotypic characteristics of pediatric CD.
Efficacy of Adalimumab in Moderate-to-Severe Pediatric Crohn's Disease
The American Journal of Gastroenterology, 2009
The use of tumor necrosis factor-alpha (TNF-) antagonists has changed the therapeutic strategy for Crohn ' s disease (CD). Adalimumab (ADA), a fully human anti-TNF-monoclonal antibody, is an effective therapy for patients with CD, both naive patients and those intolerant or refractory to Infl iximab (IFX), a chimeric anti-TNF-agent. However, the use of ADA is rarely reported in pediatric CD. We performed an open prospective evaluation of short-and long-term effi cacy and safety of ADA in children with moderate-to-severe CD.