Clinical features and outcomes of perianal disease in pediatric onset Crohn's disease.

BACKGROUND

Limited data have explored perianal involvement in pediatric Crohn's disease (CD). We aimed to investigate the characteristics and clinical outcomes of pediatric onset CD with perianal disease.

METHODS

The medical records of diagnosed CD with perianal disease were reviewed retrospectively. The clinical characteristics, genetic testing, treatments and surgical outcomes among very early onset (VEO group) and later onset (LO group) were investigated. The occurrence of perianal fistulizing CD (pfCD) and intestinal resection were analyzed.

RESULTS

Of the 155 included patients, 52.3 % and 47.7 % were enrolled in VEO and LO group, respectively. At diagnosis, VEO patients had more colonic and rectal involvement and higher disease activity score (P < 0.001). A monogenic disease was found in 94.9 % (74/78) of patients in VEO group and in 28.6 % (2/7) of patients in LO group. Infliximab treatment was more common among LO group (P < 0.001). VEO group had a higher rate of intestinal resection (P < 0.001). During follow-up, an additional 13 VEO patients and 8 LO patients developed pfCD. Moreover, B2 behavior and recto-vaginal fistulae were found to be predictive factors for intestinal resection.

CONCLUSION

VEOCD with perianal involvement is associated with higher monogenic mutation, more severe disease phenotypes, less utilization of biologics and higher rate of intestinal resection than LOCD.