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P257. Comparison of first recurrence rates between pediatric Crohn's disease and young adult onset Crohn's disease

D.I. Park1, E.R. Kim2, Y.S. Kim3, K.C. Huh4, K.-M. Lee5, C.K. Lee6, 1Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Internal medicine, Seoul, South Korea, 2Samsung Medical Center, Sungkyunkwan University School of Medicine, Medicine, Seoul, South Korea, 3Seoul Paik Hospital, Inje University College of Medicine, Internal medicine, Seoul, South Korea, 4Konyang University College of Medicine, Internal medicine, Daejeon, South Korea, 5St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Internal medicine, Suwon, South Korea, 6Kyung Hee University School of Medicine, Internal medicine, Seoul, South Korea

Background

Although the incidence of pediatric CD is lower than adult onset CD, its rate is rapidly increasing. However, it is not yet established whether long-term prognosis of pediatric CD is different from young adult onset CD. The aims of our study were to compare the first recurrence rates between pediatric and young adult onset CD and to analysis a long-term prognosis.

Methods

We performed a retrospective study of 479 patients with newly diagnosed CD in six university hospitals of Korea from January 2001 to January 2011. All patients were analyzed for disease phenotype at diagnosis according to Montreal classification. The patients diagnosed with CD under the age of 17 were assigned to pediatric CD group (Group 1) and those between age of 18 and 39 were assigned to young adult onset CD group (Group 2). The first recurrence was defined as an episode of increased disease activity requiring surgical bowel resection or anti TNF-alpha agent (Infliximab) or immunosuppressant (Azathioprine, 6-Mercaptopurine) after the first clinical remission. The first serious recurrence was defined as an episode requiring surgical bowel resection or anti TNF-alpha agent.

Results

54 patients and 291 patients were included in Group 1 and Group 2, respectively. During follow-up period, 15 patients of Group 1 and 130 patients of Group 2 experienced the first recurrence. 12 patients of Group 1 and 66 patients of Group 2 experienced the first serious recurrence. One, 5, and 10-year cumulative first serious recurrence rates of Group 1 were 18.5%, 32.3%, and 100%, respectively, whereas the rates of Group 2 were 11.5%, 26.3%, and 41.8%, respectively. The cumulative first serious recurrence rates were significantly higher in Group 1 than Group 2 (p = 0.038). Furthermore, there was a significant difference of cumulative first serious recurrence rates between two groups after adjusting covariates including sex, disease location, disease behavior, perianal lesion and medications of CD (hazard ratio 2.0; 95% CI 1.04–3.86).

Conclusion

The cumulative first serious recurrence rate of pediatric CD is significantly higher than young adult onset CD. These results indicate worse long-term prognosis of pediatric CD. Therefore, physicians should be encouraged to make appropriate treatment strategy for preventing recurrence in patients with pediatric CD.