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P137. Long-term outcome of paediatric-onset Crohn's disease: A population-based study

A. Peneau1, J. Salleron2, M. Fumery3, G. Savoye4, E. Lerebours5, J.‑L. Dupas6, V. Merle7, A. Cortot8, O. Mouterde9, C. Spyckerelle10, D. Djeddi11, D. Turck12, L. Peyrin-Biroulet13, J.‑F. Colombel14, C. Gower-Rousseau15

1Lille University Hospital, Gastroenterology, Lille, France; 2Lille University Hospital, Epidemiology Unit, Lille, France; 3Amiens University and Hospital, Gastroenterology, Amiens, France; 4Hôpital Charles Nicolle, Department of Gastroenterology, Rouen, France; 5Hôpital Charles Nicolle, Rouen, France; 6Amiens University Hospital North Hospital, Dept. of Hepagastroenterology, Amiens, France; 7Hospital and University, Rouen, France; 8Lille University Hospital, Lille, France; 9Rouen University and Hospital, Paediatric Unit, Rouen, France; 10St Vincent Hospital, Paediatric Unit, Lille, France; 11Amiens University and Hospital, Paediatric Unit, Amiens, France; 12Lille University Hospital, Paediatric Unit, Lille, France; 13University Hospital of Nancy, Hepato-Gastroenterology, Vandoeuvre-Lès-Nancy, France; 14Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France; 15Lille University Hospital, Epidemiology Unit, EPIMAD Registry, Lille, France

Background: Data on long-term outcome of paediatric-onset Crohn's disease (CD) are scarce.

Methods: All patients under the age of 17 years at diagnosis of definite or probable CD [1] between 1988 and 2004 recorded by EPIMAD Registry were included.

Results: 538 patients with paediatric-onset CD were identified (8.5% of all cases of CD), including 293 males. The median age at diagnosis was 14 years [IQR: 12–16] and the median duration of follow-up was 11.5 years [IQR: 7–15]. Disease location was stable over time in 75% of them, 11% of patients progressed to more extensive disease, and healing of colonic lesions during follow-up was reported in 14% of patients with ileocolonic disease (L3 according to Montreal classification). The percentage of complicated behaviour (B2 or B3 according to Montreal classification) increased from diagnosis to last news: 73% vs 42% (B1); 24% vs 39% (B2); and 4% vs 19% (B3); p < 10–3. Cumulative probabilities of receiving immunosuppressors and anti‑TNF therapy were respectively 22% et 2% at 1 year, 51% and 16% at 5 years, 66% and 29% at 10 years, and 74% and 49% at 20 years. Cumulative probabilities of first intestinal resection were 9%, 15%, 31%, 44% and 54% at 1, 2, 5, 10 and 20 years.

Conclusions: In this large population-based cohort, the natural history of paediatric-onset CD was characterized by a stable disease location in 75% of patients and a complicated behaviour in 60% of them after a median follow-up of 11.5 years. Twenty years after diagnosis, three-quarters of patients would have received immunosuppressors, about half an anti‑TNF therapy, and half of patients would have required an intestinal resection.

1. Gower-Rousseau C (1994), Incidence of inflammatory bowel disease in northern France (1988–1990). Gut.