Pediatric Crohn's disease from onset to adulthood: granulomas are associated with an early need for immunomodulation

Pediatric Crohn's disease from onset to adulthood : granulomas are associated with an early need for immunomodulation

OBJECTIVE: Childhood onset Crohn's disease (CD) is considered more aggressive than adult onset disease. Epithelioid cell granulomas in intestinal biopsies are one, non-obligate, criterion of CD. We investigated granulomas as markers of CD severity in children followed to adulthood.MATERIAL AND METHODS: Forty-five individuals with childhood onset CD were studied from diagnosis until attainment of final height, with data on disease location, medical and surgical management and with detailed growth data analyses. A blinded review of diagnostic biopsies was also performed.RESULTS: We found granulomas in 22/45 (49%) children at diagnosis, altogether in 28/45 (62%) patients during the disease course (median overall follow-up - 12.3 years, range 9.3-18). Granulomas were found in 9/11 (82%) with upper gastrointestinal involvement (cumulatively 17/20, 85%) (p = 0.017 and p = 0.006, respectively). The time from diagnosis to initiating immune modulating treatment (median 4.5 months, range 0-75) was shorter in the granuloma-positive group (16/22) compared to the granuloma-negative group (18/23) (median 33 months, range 2-105; p = 0.01). The median standard deviation score height at diagnosis and final adult height (both adjusted for target height) did not correlate to findings of granulomas.CONCLUSIONS: Epithelioid cell granulomas were associated with a shorter time to initiating immune modulating drugs, as a possible sign of more severe disease, but growth was not affected.

Rubio, Carlos AKarolinska Institutet (författare)
Onelöv, Erik (författare)
Henter, Jan-IngeKarolinska Institutet (författare)
Fagerberg, Ulrika LKarolinska Institutet,Uppsala universitet,Centrum för klinisk forskning, Västerås(Swepub:uu)ulrfa951 (författare)
Finkel, YigaelKarolinska Institutet (författare)
Karolinska InstitutetCentrum för klinisk forskning, Västerås (creator_code:org_t)

Ingår i:Scandinavian Journal of Gastroenterology: Informa UK Limited49:8, s. 950-70036-55211502-7708

Av författaren/redakt...: Ideström, Maja; Rubio, Carlos A; Onelöv, Erik; Henter, Jan-Inge; Fagerberg, Ulrik ...; Finkel, Yigael

Om ämnet

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Gastroenterologi

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