Brief Article
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World J Gastroenterol. Apr 14, 2013; 19(14): 2217-2226
Published online Apr 14, 2013. doi: 10.3748/wjg.v19.i14.2217
Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort
Barbara Dorottya Lovasz, Laszlo Lakatos, Agnes Horvath, Istvan Szita, Tunde Pandur, Michael Mandel, Zsuzsanna Vegh, Petra Anna Golovics, Gabor Mester, Mihaly Balogh, Csaba Molnar, Erzsebet Komaromi, Lajos Sandor Kiss, Peter Laszlo Lakatos
Barbara Dorottya Lovasz, Michael Mandel, Zsuzsanna Vegh, Petra Anna Golovics, Lajos Sandor Kiss, Peter Laszlo Lakatos, First Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary
Laszlo Lakatos, Istvan Szita, Tunde Pandur, Department of Medicine, Csolnoky F Province Hospital, H-8200 Veszprem, Hungary
Agnes Horvath, Department of Pediatrics, Csolnoky F Province Hospital, H-8200 Veszprem, Hungary
Gabor Mester, Mihaly Balogh, Department of Medicine, Grof Eszterhazy Hospital, H-8500 Papa, Hungary
Csaba Molnar, Department of Infectious Diseases, Magyar Imre Hospital, H-8400 Ajka, Hungary
Erzsebet Komaromi, Department of Gastroenterology Municipal Hospital, H-8100 Varpalota, Hungary
Author contributions: Lovasz BD and Lakatos L contributed equally to this work; Lovasz BD contributed to supervision, patient selection and validation, database construction and manuscript preparation; Lakatos L contributed to study design, data collection, supervision, patient selection and validation, database construction, and manuscript preparation; Pandur T, Mester G, Balogh M, Szita I, Molnar C, Komaromi E, Mandel M, Vegh Z, Golovics PA and Kiss LS contributed to database construction and manuscript preparation; Lakatos PL contributed to study design, data collection, supervision, patient selection and validation, database construction, statistical analysis, and manuscript preparation; all authors have approved the final draft submitted.
Supported by Semmelweis University Regional and Institutional Committee of Science and Research Ethics and the Csolnoky F Province Hospital Institutional Committee of Science and Research Ethics
Correspondence to: Peter Laszlo Lakatos, MD, PhD, First Department of Medicine, Semmelweis University, Korányi S. 2/A, H-1083 Budapest, Hungary. lakatos.peter_laszlo@med.semmelweis-univ.hu
Telephone: +36-1-2100278 Fax: +36-1-3130250
Received: November 7, 2012
Revised: November 27, 2012
Accepted: December 20, 2012
Published online: April 14, 2013
Abstract

AIM: To investigate the evolution of disease phenotype in adult and pediatric onset Crohn’s disease (CD) populations, diagnosed between 1977 and 2008.

METHODS: Data of 506 incident CD patients were analyzed (age at diagnosis: 28.5 years, interquartile range: 22-38 years). Both in- and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008 in adult and pediatric onset CD populations. Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis.

RESULTS: Among this population-based cohort, seventy-four (12.8%) pediatric-onset CD patients were identified (diagnosed ≤ 17 years of age). There was no significant difference in the distribution of disease behavior between pediatric (B1: 62%, B2: 15%, B3: 23%) and adult-onset CD patients (B1: 56%, B2: 21%, B3: 23%) at diagnosis, or during follow-up. Overall, the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5- and 10-years of follow-up. Similarly, time to change in disease behaviour from non stricturing, non penetrating (B1) to complicated, stricturing or penetrating (B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis. Calendar year of diagnosis (P = 0.04), ileal location (P < 0.001), perianal disease (P < 0.001), smoking (P = 0.038) and need for steroids (P < 0.001) were associated with presence of, or progression to, complicated disease behavior at diagnosis and during follow-up. A change in disease location was observed in 8.9% of patients and it was associated with smoking status (P = 0.01), but not with age at diagnosis.

CONCLUSION: Long-term evolution of disease behavior was not different in pediatric- and adult-onset CD patients in this population-based cohort but was associated to location, perianal disease and smoking status.

Keywords: Crohn’s disease, Age at diagnosis, Disease behavior, Disease course