Natural history of Crohn's disease: Comparison between childhood‐ and adult‐onset disease

• Published in: Inflammatory bowel diseases Vol. 16; no. 6; pp. 953 - 961
• Main Authors: Pigneur, Bénédicte, Seksik, Philippe, Viola, Sheila, Viala, Jérôme, Beaugerie, Laurent, Girardet, Jean‐Philippe, Ruemmele, Frank M., Cosnes, Jacques
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.06.2010; Lippincott, Williams & Wilkins
• Subjects: Adolescent; Adult; Age of Onset; Chemical Sciences; Child; Child, Preschool; childhood‐onset; comparison; Crohn Disease - complications; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Crohn Disease - mortality; Crohn's disease; Female; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Organic chemistry; Prospective Studies; severity; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.21152

Background: Childhood‐onset Crohn's disease (CD) might reflect a more severe form of disease. To test this hypothesis we analyzed the long‐term natural history of CD in an adult cohort of patients with childhood‐onset compared to adult‐onset CD. Methods: We selected 206 childhood‐onset CD patients among 2992 adult patients with a diagnosis of CD established before December 31, 2000. Disease characteristics were prospectively assessed during follow‐up until December 2007 and compared to adult‐onset CD patients matched 2 to 1 on gender, year of CD diagnosis, and disease location. Results: Compared to adult‐onset CD, patients with childhood‐onset CD were more likely to have a severe disease, with an increased year‐by‐year disease activity index (37% of patient‐years in childhood‐onset group versus 31% in the adult‐onset group, P < 0.001). Immunosuppressant requirement was also increased with a 10‐year cumulative risk of 54 ± 3% in childhood‐onset CD group versus 45 ± 2%, in the adult‐onset CD group (P < 0.001). Cumulative risks of stricturing and penetrating complications and surgical resections were not statistically different between groups. Accordingly, these events occurred at a younger age in the childhood‐onset CD group. At the age of 30 years the actuarial risk of having undergone an extensive intestinal resection was 48 ± 5% in the childhood‐onset group versus 14 ± 2% in the adult‐onset group (P < 0.001). Conclusions: Patients with childhood‐onset CD exhibit a more active disease and require more immunosuppressive therapy. This feature is observed irrespective of the disease location, suggesting an intrinsic more severe phenotype. Inflamm Bowel Dis 2009