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DOP057 Perianal pediatric Crohn's disease is associated with a distinct phenotype and greater inflammatory burden

Assa A.*1, Amitai M.2, Greer M.-L.3, Castro D.3, Cytter Kuint R.4, Martínez-Leόn M.5, Herman-Sucharska I.6, Coppenrath E.7, Anupindi S.8, Towbin A.9, Moote D.10, Konen O.11, Pratt L.-T.12, Grifitths A.3, Turner D.4

1Schneider Children's Medical Center, Gastroenterology, Nutrition and Liver Diseases, Petach Tikva, Israel 2Sheba Medical Center, Department of Radiology, Ramat Gan, Israel 3Hospital for Sick Children, Toronto, Canada 4Shaare Zedek Medical Center, Jerusalem, Israel 5Hospital Regional Universitario Carlos Haya, Malaga, Spain 6Jagiellonian University in Cracow, Cracow, Poland 7University of Munich, Munich, Germany 8The Children's Hospital of Philadelphia, Philadelphia, United States 9Cincinnati Children's Hospital, Cincinnati, United States 10Connecticut Children's Medical Center, Hartford, United States 11Schneider Children's medical Center, Petach Tikva, Israel 12Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel

Background

Data on the outcomes of children with perianal Crohn's disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults.

Methods

Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months.

Results

Of the 234 included patients [mean age 14.2±2.4 years; 131 (56%) males], 57 (24%) had perianal findings while only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z-scores compared with non-pCD patients (−0.9 vs. −0.35, p=0.03 and −0.68 vs. −0.23, respectively; p=0.04), higher weighted pediatric Crohn's disease activity index [32 (IQR 16–50) vs. 20 (8–37); p=0.004], lower serum albumin (3.6±0.7 vs. 4.5±0.8, p=0.016) and higher magnetic resonance enterography (MRE) global inflammatory score (p=0.04). Children with pCD had more rectal (57% vs. 38%, p=0.04), and jejunal involvement (31% vs. 11% p=0.003) and a higher prevalence of granulomas (64% vs. 23%, p=0.0001). MRE-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic and radiologic characteristics as patients with no perianal findings.

Conclusion

Pediatric pCD patients with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.