P459 Characteristics of Pediatric Crohn's Disease in a Tertiary Center in China according to Paris Classification
K. Chao*, X. Gao, J. Guo, N. Ding, M. Zhi, P. Hu
The Sixth Affiliated Hospital, Sun Yat-sen Universtity, Gastroenterolgy and Hepatology, Guangzhou, China
Paris Classification was recently validated to better characterize inflammatory bowel disease (IBD), especially pediatric IBD. In contrast to the Montreal classification which all patients <17 years were grouped as A1, the Paris classification recognizes Crohn's disease (CD) patients aged <10 years as A1a and those 10-17 years as A1b. A few retrospective studies have analyzed the incidence and phenotype of pediatric CD according to the new classification whereas data was limited in Chinese. So the present retrospective study aimed to analyze the characteristics of pediatric Crohn's disease in Chinese population according to Paris classification.
Consecutive patients (Age <17 years) diagnosed as CD in our IBD center from January 2007 to July 2014 were enrolled. Diagnosis was based on the latest ECCO guideline. Clinical data was collected and the phenotype was classified according to the Paris classification.
Ninety-two patients were included, which account for 21.9% of all CD patients diagnosed during the same period. Among them, 22(23.9%) were diagnosed before 10 years old (A1a group). 70(76.1%) were diagnosed between 10-17 years old (A1b group). In the A1a group, there were 2 L1 (9.1%), 2 L2 (9.1%), 8 L3 (36.3%), 7 L3L4b (31.8%), 1 L1L4b (4.5%), 2 L3L4aL4b (9.1%).In the A1b group, there were 3 L1(4.3%),12 L2(17.1%),51 L3(72.9%), 4 L3L4b(5.7%).The upper gastrointestinal tract involvement was significantly higher in A1a group(P<0.05). 6(27.3%) patients behaved as penetrating behavior and 1 with stricture(4.5%) in A1a group, while in A1b group,10 patients(14.2%) behaved as penetrating behavior and 19(27.1%)with stricture(P<0.05). The proportion of perianal involvement was 6(27.2%) in A1a group and 38(54.2%) in A1b group (P<0.05). The proportion of growth retardation was significantly higher in A1a group (59.2v.s. 28.6%, P<0.05). During the first year after disease diagnosis, 2 patients with penetrating behavior in A1a group experienced intestinal surgery and 1 patient in A1b group experienced intestinal surgery because of stricture.
The phenotype of pediatric CD may be different between different age groups. Those with early on-set seemed to be with more extensive distribution, higher risk of upper gastrointestinal tract involvement as well as growth retardation. The Paris classification is a useful tool to discriminate the very early onset pediatric CD who believed to have different pathogenesis from other age group. Further study should be conducted to determine if this stratification would predict prognosis and benefit our treatment strategy.