Disease location as a predictor for clinical outcomes in Paediatric Crohn’s Disease.

Abstract

Background & aims Disease location is a known predictor of adverse outcomes in paediatric Crohn’s Disease, but data on clinical medium- and long-term outcomes are lacking. This study aims to evaluate disease location as a predictor of biochemical remission, disease severity, medication use, growth and adverse outcomes in paediatric Crohn’s. Methods 396 participants with paediatric Crohn’s Disease were included and prospectively reviewed at set time points. Clinical data was calculated into disease activity scores and combined with laboratory results to compose the primary outcome. Results 24.5% of participants had isolated ileal disease, 17.4% had isolated colonic disease and 58.1% had ileocolonic disease at baseline. Isolated ileal disease was associated with longer median time to diagnosis (209 ± 260 days) and more complicated disease at baseline. Ileocolonic disease was associated with higher prevalence of upper gastrointestinal disease, higher inflammation markers and lower albumin. Isolated ileal disease was associated with less achievement of biochemical remission within one year follow up, but not with sustained biochemical remission at one year follow up. Multivariate analysis showed no association between disease location (HR 0.45; 95%CI 0.20-1.01; p=0.053) and time to biochemical remission or time to biological treatment (HR 1.37; 95%CI 0.98-1.90; p=0.062). Conclusion In paediatric Crohn’s Disease, ileal involvement is associated with less biochemical remission within one year and unfavourable disease characteristics at baseline. Further research is needed to establish the relationship between disease location and prolonged biochemical remission.