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P213 Predicting outcome of paediatric Crohn’s disease: role of clinical, endoscopic, and imaging findings at the diagnosis

M. Aloi*1, F. Civitelli1, S. Oliva1, E. Casciani2, G. D’Arcangelo1, A. Spatoliatore1, F. Viola1, S. Cucchiara1

1Sapienza University of Rome, Paediatric gastroenterology and liver Unit, Rome, Italy, 2Sapienza University of Rome, Radiology DEA, Rome, Italy

Background

Aims of this study were to evaluate the predictive value of clinical, laboratory endoscopic and imaging factors at the diagnosis for the risk of surgery and complicated disease course in children with Crohn’s disease (CD).

Methods

In this single-centre, prospective, longitudinal study, children newly diagnosed with CD were enrolled and followed for 3 years. At baseline, all patients underwent a clinical evaluation (Paediatric Crohn’s Disease Activity Index [PCDAI]), laboratory exams (including C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR], magnetic resonance imaging [MRI], and ileocolonoscopy). Disease location and behaviour were defined according to Paris classification.1 Simple endoscopic score for CD (SES-CD)2 was used to evaluate the severity of endoscopic lesions. Rate of surgery at maximum follow-up was the primary outcome evaluated.

Results

Enrolled were 50 patients (64% males, median age 12.7 ± 2.9 years). Mean SES-CD at the diagnosis was 15.3 ± 10.6. A SES-CD graded as severe (>15) was present in 20/50 (40%) patients. MRI showed ulcers in 7/50 (14%) patients, stenosis in 20/50 (40%), pre-stenotic bowel dilation in 14/50 (28%), abscesses in 3/50 (6%), and fistulas in 7/50 (14%). The presence of stenosis at ileocolonoscopy (p = 0.009) and fistulae at MRI (p = 0.05) correlated with the need of resection surgery at follow-up. At a multivariate analysis, penetrating disease (r 0.65 [0.40 to 0.81]; p < 0.0001), perianal involvement (0.41 [0.15 to 0.62];p = 0.002), stenosis at ileocolonoscopy (r 0.30 [0.03 to 0.53];p = 0.02), and fistula at MRI (r 0.41 [0.15 to 0.62]; p = 0.002) at the diagnosis increased the surgical risk at follow-up, whereas inflammatory behaviour (B1) (r -0.4 [-0.6 to -0.1]; p = 0.006) and ESR >25 mm/h (r -0.3 [-0.5 to -0.03]; p = 0.03) were negatively associated.

Conclusion

Penetrating behaviour and perianal disease at the diagnosis along with the presence of stenosis at ileocolonoscopy and fistulae at MRI are independent predictive factors of the surgical risk in children with CD. An inflammatory behaviour and high ESR seem to correlate with a milder disease course.

References

[1] Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 2011;17(6):1314–21.

[2] Daperno M D’Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc 2004;60(4):505–12.