Crohn's disease in children: Assessment of the progression of disease, growth, and prognosis

There were 177 children less than 15 yr of age treatment for Crohn's disease. Twenty percent had a family history of inflammatory bowel disease. Fifty-three percent had small bowel disease, 44% had both small and large bowel disease, and 3% had isolated colonic involvement. Fifty-eight children (33%) were treated medically. One hundred nineteen patients (67%) required operative therapy. Fity-nine percent had one operation, 22% had two operations, and 19% had three or more operations. Follow-up ranged from 1.3 to 30 yr. The probability of additional surgery was influenced by the length of the follow-up interval, beginning at the date of the last operation. In children requiring one operation, the likelihood of further surgery was 7% at 1 yr, 36% at 5 yr, and 48% at 10 yr of follow-up. Patients having both small intestinal and colonic involvement had a significantly greater chance of requiring reoperation. The mean height of all children with Crohn's disease was significantly less than the mean of the normal population. Patients requiring surgery were significantly shorter than children treated medically. Operation resulted in a significant increase in growth immediately after surgery. The rate of growth in height from time of diagnosis to final adult follow-up was greatest for operated patients. The growth rate for medically treated patients was significantly less. Upon reaching adulthood, both surgically and medically treated patients were essentially the same size and were significantly shorter than average in height. At last follow-up, 71% of all patients were not limited in activity by their disease and 80% considered their state of health to be good to excellent. Survival of patients with Crohn's disease compared very favorably with that of the normal population. After 5 yr the survival rate was 98% of expected. After 20 yr the survival rate was 89% of expected.