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P351. Gender impact on the clinical presentation of the newly diagnosed, pediatric-onset Crohn's disease: A single center registry-based study

M.K. Sladek

Jagiellonian University School of Medicine, Krakow, Poland

Background and Aims: Gender-related differences of pediatric-onset Crohn's Disease (CD) at the time of diagnosis are poorly described. The aim of the study was to define the impact of gender on clinical presentation of pediatric-onset, treatment-naive CD patients.

Patients and Methods: Diagnosis and management of pediatric inflammtory bowel disease (IBD) patients requires a specialist care and Department of Pediatrics, Gastroenterology and Nutrition serves as a specialized pediatric gastroenterology referral center for Malopolska province. As of May 1, 2004 a prospective enrollment into the registry and electronic database collection was began for pediatric IBD patients. Self-reported standardized questionnaire covering demographic data (age, sex, ethnicity, place of residence, family IBD history) was applied individually and completed by patients and/or parents at the time of diagnosis. Signs and symptoms related to CD were collected and included presence or absence of abdominal pain/cramps, diarrhea, rectal bleeding, sensation associated with defecation, nausea/vomiting, fatigue, fever, joint problem, erythema nodosum, mouth sores, liver and biliary tract involvement, and weight and growth abnormalities. Diagnosis of CD was based on the Porto criteria. Disease location and phenotype were established by the abnormal histology or CD-compatible radiology at ±3 months from diagnosis and were classified according to the Montreal classification. Demographic and clinical data of newly-diagnosed CD boys and girls under the age of 18, based on the prospective IBD patients registry and self-reported questionnaire, were compared.

Results: From the entire group of 146 patients, 82 were boys and 64 were girls (56.2% vs. 43.8%). No differences were found for either the mean age of the onset of symptoms (9.98±4.69 vs.11.33±4.53 years, p = 0.08) or for the lag-time between CD-related symptoms and establishing of diagnosis (13.65±21.66 vs. 15.52±22.66 month, p = 0.79). Boys were significantly younger at the time of diagnosis (11.25±4.48 vs. 12.71±4.33 years, p = 0.04). Significantly more frequently girls presented with more active disease as assessed by PCDAI (65.6% vs.40.7%, p = 0.02) with an OR = 2.53 for lower hemoglobin level (CI 95% 2.28–5.01, p = 0.007), an OR = 1.93 for hypoalbuminemia (CI 95% 0.92–4.04, p = 0.07) and an OR = 2.47 for increased ERS (CI 95%, 1.17–5.13, p = 0.01). Frequency of gastrointestinal and extraintestinal symptoms in boys and girls were comparable for all but higher frequency of sensation associated with defecation in boys with and OR = 2.556 (CI 95%, 1.27–5.13, p = 0.007). Inflammatory behavior and ileocecal localization were seen most frequently in both groups and no gender differences were found by initial disease classification.

Conclusion: In pediatric-onset CD, boys predominated and they were diagnosed at the younger age compared with girls. More frequently girls presented more active CD and were at the higher risk for linear growth impairment and abnormal laboratory results. CD phenotype did not appear to differ by gender at the time of diagnosis. Genetic or/and hormonal factors could be involved in the gender difference in susceptibility to CD and severity of the disease.