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P550. Diagnosing and treating pediatric Crohn's disease patients: is there a difference between adult and pediatric gastroenterologists' practices? Results of the BELCRO cohort

E. De Greef1, B. Maus2, I. Hoffman3, F. Smets4, S. Van Biervliet5, M. Scaillon6, B. Hauser7, I. Paquot8, P. Alliet9, W. Arts10, O. Dewit11, H. Peeters12, F. Baert13, G. D'Haens14, J.-F. Rahier15, I. Etienne16, O. Bauraind8, A. Van Gossum17, S. Vermeire18, F. Fontaine19, V. Muls20, E. Louis21, F. Van De Mierop22, J. Coche23, J.J. Mahachie2, K. Van Steen2, G. Veereman24, 1UZ Brussels, Pediatric Gastroenterology, Jette, Belgium, 2ULG, Montefiore Institute, Liege, Belgium, 3Uz Gasthuisberg, Pediatric Gastroenterology, Leuven, Belgium, 4UCL St Luc, Pediatric Gastroenterology, Brussel, Belgium, 5UZ Gent, Pediatric Gastroenterology, Gent, Belgium, 6Hôpital des enfants Reine Paola, Pediatric Gastroenterology, Brussel, Belgium, 7UZ Brussels, Pediatric Gastroenterology, Brussel, Belgium, 8CHC Clinique de l'Esperance, Pediatric Gastroenterology, Liege, Belgium, 9Jessa Hospital, Pediatric Gastroenterology, Hasselt, Belgium, 10ZOL, Pediatric Gastroenterology, Genk, Belgium, 11UCL St Luc, Gastroenterology, Brussel, Belgium, 12UZ Gent, Gastroenterology, Gent, Belgium, 13Heilig Hart Hospital, Gastroenterology, Roesselare, Belgium, 14AMC, Gastroenterology, Amsterdam, Netherlands, 15UCL Montgodinne, Gastroenterology, Mont Godinne, Belgium, 16CHR Citadelle, Pediatric Gastroenterology, Liege, Belgium, 17ULB Erasme, Gastroenterology, Brussel, Belgium, 18Uz Gasthuisberg, Gastroenterology, Leuven, Belgium, 19CHU St Joseph, Gastroenterology, Liege, Belgium, 20ULB St Pierre, Gastroenterology, Brussel, Belgium, 21ULG, Gastroenterology, Liege, Belgium, 22AZ St Augustinus, Gastroenterology, Wilrijk, Belgium, 23Clinique Saint Pierre, Gastroenterology, Ottignies, Belgium, 24UZ Brussels, Pediatric Gastroenterology, Brussels, Belgium

Background

Pediatric gastroenterologists treat Crohn's disease patients up to 15–18 years of age and then transfer them to adult care. However, there is no restriction for adult colleagues to diagnose and treat pediatric patients.

Methods

In the current survey, we investigated differences in presentation, use of diagnostic procedures and initial treatment for pediatric Crohn's disease patients under the care of pediatric versus adult gastroenterologists. This comparison was made in the cohort of BELCRO patients diagnosed by a pediatric or adult gastroenterologist.

Results

In the BELCRO cohort, 71% of patients were diagnosed by a pediatric gastroenterologist of whom 58% in a tertiary care centre compared to 37% of the 29% of patients in adult care. Even though patients diagnosed by adult physicians are significantly older, 22% were below the age of 12 y. No difference in presenting symptoms (abdominal pain, diarrhoea, growth failure) or disease severity at diagnosis was found between both groups. Disease classification according to Montreal [1] and the recently adapted Paris [2] classification was similar. Pediatric gastroenterologists performed as many upper endoscopies at diagnosis before and after publication of the Porto criteria (75%) [3], whereas adult physicians performed significantly less upper endoscopies. At diagnosis, adult physicians initially prescribed more monotherapy with 5-ASA and were less inclined to use combination therapy with steroids, immunomodulators, antibiotics or enteral nutrition compared to pediatric colleagues.

Conclusion

Further follow up will indicate whether differences between pediatric and adult practitioners affect long term disease behaviour and outcome.

1. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19 Suppl A:5–36

2. Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. IBD. 2011;17:1314–1321

3. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis--the Porto criteria. J Pediatr Gastroenterol Nutr. 2005;41:1–7