Perianal Crohn's Disease is More Common in Children and is Associated with Complicated Disease Course Despite Higher Utilization of Biologics: A Population-based Study from the epiIIRN
Both perianal and pediatric-onset Crohn's disease (CD) disease are associated with complicated disease course and higher drug utilization. We aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course. We included all patients with newly diagnosed CD...
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| Veröffentlicht in: | Journal of pediatric gastroenterology and nutrition 2022-02 |
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| container_title | Journal of pediatric gastroenterology and nutrition |
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| creator | Atia, Ohad Focht, Gili Lujan, Rona Ledder, Oren Greenfeld, Shira Kariv, Revital Dotan, Iris Yanai, Henit Gabay, Hagit Balicer, Ran Haklai, Ziona Nevo, Daniel Turner, Dan |
| description | Both perianal and pediatric-onset Crohn's disease (CD) disease are associated with complicated disease course and higher drug utilization. We aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course.
We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing PCD and its severity according to the association with simple and complex perianal disease.
A total of 12,905 patients were included (2,186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1,530 (12%) patients, with higher incidence in children (308 [14%] children vs. 1,222 adults [11%]; p |
| doi_str_mv | 10.1097/MPG.0000000000003422 |
| format | Article |
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We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing PCD and its severity according to the association with simple and complex perianal disease.
A total of 12,905 patients were included (2,186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1,530 (12%) patients, with higher incidence in children (308 [14%] children vs. 1,222 adults [11%]; p < 0.001). Children had higher incidence of severe PCD (141/308 [47%] vs 433/1,222 [35%]; p < 0.001). At five years, children with PCD were more likely than adults to be treated with biologics (212 [69%] vs 515 [42%]; OR 2.6 [95%CI 1.6-4.0]; p < 0.001) and immunomodulators (238 [74%] vs 643 [53%]; OR 2.8 [95%CI 2.1-3.6]; p < 0.001). PCD in children was still associated with poorer disease outcomes as shown for surgeries (36 [12%] vs 93 [8%]; p = 0.02) and steroid-dependency (52 [17%] vs 156 [13%]; p < 0.001). Multivariable modelling indicated that the severity of PCD is a stronger predictor of disease course than age.
PCD is more common in pediatric-onset CD and is associated with higher drug utilization and worse disease outcomes, in large due to higher rate of severe PCD in children.</description><identifier>ISSN: 0277-2116</identifier><identifier>EISSN: 1536-4801</identifier><identifier>DOI: 10.1097/MPG.0000000000003422</identifier><identifier>PMID: 35192577</identifier><language>eng</language><publisher>United States: by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology</publisher><ispartof>Journal of pediatric gastroenterology and nutrition, 2022-02</ispartof><rights>by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology</rights><rights>Copyright © 2022 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35192577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Atia, Ohad</creatorcontrib><creatorcontrib>Focht, Gili</creatorcontrib><creatorcontrib>Lujan, Rona</creatorcontrib><creatorcontrib>Ledder, Oren</creatorcontrib><creatorcontrib>Greenfeld, Shira</creatorcontrib><creatorcontrib>Kariv, Revital</creatorcontrib><creatorcontrib>Dotan, Iris</creatorcontrib><creatorcontrib>Yanai, Henit</creatorcontrib><creatorcontrib>Gabay, Hagit</creatorcontrib><creatorcontrib>Balicer, Ran</creatorcontrib><creatorcontrib>Haklai, Ziona</creatorcontrib><creatorcontrib>Nevo, Daniel</creatorcontrib><creatorcontrib>Turner, Dan</creatorcontrib><title>Perianal Crohn's Disease is More Common in Children and is Associated with Complicated Disease Course Despite Higher Utilization of Biologics: A Population-based Study from the epiIIRN</title><title>Journal of pediatric gastroenterology and nutrition</title><addtitle>J Pediatr Gastroenterol Nutr</addtitle><description>Both perianal and pediatric-onset Crohn's disease (CD) disease are associated with complicated disease course and higher drug utilization. We aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course.
We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing PCD and its severity according to the association with simple and complex perianal disease.
A total of 12,905 patients were included (2,186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1,530 (12%) patients, with higher incidence in children (308 [14%] children vs. 1,222 adults [11%]; p < 0.001). Children had higher incidence of severe PCD (141/308 [47%] vs 433/1,222 [35%]; p < 0.001). At five years, children with PCD were more likely than adults to be treated with biologics (212 [69%] vs 515 [42%]; OR 2.6 [95%CI 1.6-4.0]; p < 0.001) and immunomodulators (238 [74%] vs 643 [53%]; OR 2.8 [95%CI 2.1-3.6]; p < 0.001). PCD in children was still associated with poorer disease outcomes as shown for surgeries (36 [12%] vs 93 [8%]; p = 0.02) and steroid-dependency (52 [17%] vs 156 [13%]; p < 0.001). Multivariable modelling indicated that the severity of PCD is a stronger predictor of disease course than age.
PCD is more common in pediatric-onset CD and is associated with higher drug utilization and worse disease outcomes, in large due to higher rate of severe PCD in children.</description><issn>0277-2116</issn><issn>1536-4801</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNpNkUFv1DAUhC1ERZfCP0DIN05pbceObW5LWtqVWli15bzyxi-NwYkj29Gq_DJ-Htm2K_VdRpoZfYc3CH2i5JQSLc9u1pen5NWVnLE3aEFFWRVcEfoWLQiTsmCUVsfofUq_55LkgrxDx6WgmgkpF-jfGqIzg_G4jqEbviR87hKYBNglfBMi4Dr0fRiwG3DdOW8jDNgMdh8vUwqNMxks3rnc7Zujd82TcaDUYYqznEMaXQZ85R46iPhXdt79NdnN4NDiby748OCa9BUv8TqMk3-Kiu1MsPguT_YRtzH0OHeAYXSr1e2PD-ioNT7Bxxc9QfffL-7rq-L65-WqXl4XY6VoUSlpRQVlC7yk3LSKKEpnp2kks0RSprVSBuRWNdroVgnTtJxWRJTMSK5teYI-P2PHaduD3YzR9SY-bg4fnAv8ubALPkNMf_y0g7jpwPjcbfbDCCqrQh9mKrTgjJb_AXJLhUM</recordid><startdate>20220222</startdate><enddate>20220222</enddate><creator>Atia, Ohad</creator><creator>Focht, Gili</creator><creator>Lujan, Rona</creator><creator>Ledder, Oren</creator><creator>Greenfeld, Shira</creator><creator>Kariv, Revital</creator><creator>Dotan, Iris</creator><creator>Yanai, Henit</creator><creator>Gabay, Hagit</creator><creator>Balicer, Ran</creator><creator>Haklai, Ziona</creator><creator>Nevo, Daniel</creator><creator>Turner, Dan</creator><general>by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology</general><scope>NPM</scope></search><sort><creationdate>20220222</creationdate><title>Perianal Crohn's Disease is More Common in Children and is Associated with Complicated Disease Course Despite Higher Utilization of Biologics: A Population-based Study from the epiIIRN</title><author>Atia, Ohad ; Focht, Gili ; Lujan, Rona ; Ledder, Oren ; Greenfeld, Shira ; Kariv, Revital ; Dotan, Iris ; Yanai, Henit ; Gabay, Hagit ; Balicer, Ran ; Haklai, Ziona ; Nevo, Daniel ; Turner, Dan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p681-687d56e3fe4314af80811d56cc72d07129988ae7b8c9a9f85acf4160532a749d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Atia, Ohad</creatorcontrib><creatorcontrib>Focht, Gili</creatorcontrib><creatorcontrib>Lujan, Rona</creatorcontrib><creatorcontrib>Ledder, Oren</creatorcontrib><creatorcontrib>Greenfeld, Shira</creatorcontrib><creatorcontrib>Kariv, Revital</creatorcontrib><creatorcontrib>Dotan, Iris</creatorcontrib><creatorcontrib>Yanai, Henit</creatorcontrib><creatorcontrib>Gabay, Hagit</creatorcontrib><creatorcontrib>Balicer, Ran</creatorcontrib><creatorcontrib>Haklai, Ziona</creatorcontrib><creatorcontrib>Nevo, Daniel</creatorcontrib><creatorcontrib>Turner, Dan</creatorcontrib><collection>PubMed</collection><jtitle>Journal of pediatric gastroenterology and nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Atia, Ohad</au><au>Focht, Gili</au><au>Lujan, Rona</au><au>Ledder, Oren</au><au>Greenfeld, Shira</au><au>Kariv, Revital</au><au>Dotan, Iris</au><au>Yanai, Henit</au><au>Gabay, Hagit</au><au>Balicer, Ran</au><au>Haklai, Ziona</au><au>Nevo, Daniel</au><au>Turner, Dan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perianal Crohn's Disease is More Common in Children and is Associated with Complicated Disease Course Despite Higher Utilization of Biologics: A Population-based Study from the epiIIRN</atitle><jtitle>Journal of pediatric gastroenterology and nutrition</jtitle><addtitle>J Pediatr Gastroenterol Nutr</addtitle><date>2022-02-22</date><risdate>2022</risdate><issn>0277-2116</issn><eissn>1536-4801</eissn><abstract>Both perianal and pediatric-onset Crohn's disease (CD) disease are associated with complicated disease course and higher drug utilization. We aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course.
We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing PCD and its severity according to the association with simple and complex perianal disease.
A total of 12,905 patients were included (2,186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1,530 (12%) patients, with higher incidence in children (308 [14%] children vs. 1,222 adults [11%]; p < 0.001). Children had higher incidence of severe PCD (141/308 [47%] vs 433/1,222 [35%]; p < 0.001). At five years, children with PCD were more likely than adults to be treated with biologics (212 [69%] vs 515 [42%]; OR 2.6 [95%CI 1.6-4.0]; p < 0.001) and immunomodulators (238 [74%] vs 643 [53%]; OR 2.8 [95%CI 2.1-3.6]; p < 0.001). PCD in children was still associated with poorer disease outcomes as shown for surgeries (36 [12%] vs 93 [8%]; p = 0.02) and steroid-dependency (52 [17%] vs 156 [13%]; p < 0.001). Multivariable modelling indicated that the severity of PCD is a stronger predictor of disease course than age.
PCD is more common in pediatric-onset CD and is associated with higher drug utilization and worse disease outcomes, in large due to higher rate of severe PCD in children.</abstract><cop>United States</cop><pub>by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology</pub><pmid>35192577</pmid><doi>10.1097/MPG.0000000000003422</doi></addata></record> |
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| title | Perianal Crohn's Disease is More Common in Children and is Associated with Complicated Disease Course Despite Higher Utilization of Biologics: A Population-based Study from the epiIIRN |
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