Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn’s Disease: A Population-based Study

Abstract Introduction Most studies of elderly-onset Crohn’s disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD. Method All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD. Results A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p &amp;lt; 10–4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6–5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up. Conclusion During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients. </jats:sec

A Novel 8-Predictors Signature to Predict Complicated Disease Course in Pediatric-onset Crohn’s Disease: A Population-based Study

International audienceBackground The identification of patients at high risk of a disabling disease course would be invaluable in guiding initial therapy in Crohn’s disease (CD). Our objective was to evaluate a combination of clinical, serological, and genetic factors to predict complicated disease course in pediatric-onset CD. Methods Data for pediatric-onset CD patients, diagnosed before 17 years of age between 1988 and 2004 and followed more than 5 years, were extracted from the population-based EPIMAD registry. The main outcome was defined by the occurrence of complicated behavior (stricturing or penetrating) and/or intestinal resection within the 5 years following diagnosis. Lasso logistic regression models were used to build a predictive model based on clinical data at diagnosis, serological data (ASCA, pANCA, anti-OmpC, anti-Cbir1, anti-Fla2, anti-Flax), and 369 candidate single nucleotide polymorphisms. Results In total, 156 children with an inflammatory (B1) disease at diagnosis were included. Among them, 35% (n = 54) progressed to a complicated behavior or an intestinal resection within the 5 years following diagnosis. The best predictive model (PREDICT-EPIMAD) included the location at diagnosis, pANCA, and 6 single nucleotide polymorphisms. This model showed good discrimination and good calibration, with an area under the curve of 0.80 after correction for optimism bias (sensitivity, 79%, specificity, 74%, positive predictive value, 61%, negative predictive value, 87%). Decision curve analysis confirmed the clinical utility of the model. Conclusions A combination of clinical, serotypic, and genotypic variables can predict disease progression in this population-based pediatric-onset CD cohort. Independent validation is needed before it can be used in clinical practice

Long-Term Outcome of Colonic and Ileal Crohn’s Disease: A Two-Decade Population-Based Study in Pediatric-Onset Disease

International audienceIntroduction Crohn’s disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset inflammatory bowel disease (IBD). Patients and Methods All children (&lt;17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were included. The presentation at diagnosis, the risks of complications, surgery, hospitalization, and exposure to different treatments in ileal CD (CD-L1), colonic CD (CD-L2), and UC were compared. Results A total of 215 CD-L1 patients, 234 CD-L2 patients, and 337 UC patients were included. Over the study period, the annual incidence rates of CD-L1, CD-L2, and UC were 0.65 (95% CI, 0.57-0.74), 0.71 (0.62-0.81), and 1.02 (0.92-1.14) per 105 persons, respectively. At diagnosis, the proportion of males (L1 53%; L2 53%; UC 43%; P = .012), age at diagnosis (15.0; 13.7; 14.0 years; P = .003), family history of IBD (13%; 11%; 5%; P = .005), diagnostic delay (3.0; 3.0; 2.0 months; P = .001), and smoking prevalence (12%; 8%; 6%; P = .041) were different between the 3 groups. Bloody stools at diagnosis were observed in 15%, 44%, and 91% for, respectively, CD-L1, CD-L2, and UC (P &lt; .001), and diarrhea in 47%, 72%, and 65% (P &lt; .001). At diagnosis, the presence of granuloma was identified in 13% of CD-L1 patients and 31% of CD-L2 patients (P &lt; .001). The risk of extension to L3 was significantly higher in the CD-L2 group than in the CD-L1 group (at 5 years—37% vs. 14%, P &lt; .001). L2 location was associated with a lower risk of luminal fistula (hazard ratio [HR] 0.4 [0.2-0.6], P &lt; .001) but was associated with a higher risk of anoperianal lesion (HR 2.1 [1.3-3.4], P = .003). The prevalence of extraintestinal manifestations, articular (P &lt; .001) and cutaneous (P &lt; .001), was higher in CD-L2. While the 5-year risk of surgery was significantly higher in case of CD-L1 (37%, 13%, and 13%; P &lt; .001), the 5-year exposure to corticosteroids (55%, 69%, and 67%; P &lt; .001), immunosuppressants (47%, 61%, and 42%; p &lt; .001), and anti-TNF (16%, 35%, and 21%; P &lt; .001) were higher in case of L2 location. Conclusions The clinical presentation and evolution of ileal and colonic CD differ significantly in children. Colonic location is associated with a high risk of perianal CD, extraintestinal manifestations, and exposure to steroids, immunosuppressants, and anti-TNFs. These differences could justify different therapeutic approaches