Titre :

Natural history of anal ulcerations in pediatric-onset Crohn's disease: long-term follow-up of a population-based study.

Auteur(s) :

Mortreux, P. [Auteur]
Leroyer, Ariane [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Dupont, C. [Auteur]
Ley, Delphine [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Bertrand, V. [Auteur]
Spyckerelle, C. [Auteur]
Guillon, Nathalie [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Wils, Pauline [Auteur]
Institute for Translational Research in Inflammation - U 1286 [INFINITE]
Gower, Corinne [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Savoye, G. [Auteur]
Fumery, M. [Auteur]
Turck, Dominique [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Siproudhis, L. [Auteur]
Sarter, Helene [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Titre de la revue :

The American Journal of Gastroenterology

Nom court de la revue :

Am J Gastroenterol

Numéro :

118

Pagination :

p.1671-1678

Date de publication :

2023-09

ISSN :

1572-0241

Mot(s)-clé(s) en anglais :

Crohn's disease
anal ulceration
fistulizing pCD

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background: Anal ulcerations are frequently observed in Crohn's disease (CD). However, their natural history remains poorly known, especially in pediatric-onset CD. Methods: All patients with a diagnosis of CD before the ...
Lire la suite >Background: Anal ulcerations are frequently observed in Crohn's disease (CD). However, their natural history remains poorly known, especially in pediatric-onset CD. Methods: All patients with a diagnosis of CD before the age of 17 years between 1988 and 2011 within the population-based registry EPIMAD were followed retrospectively until 2013. At diagnosis and during follow-up, the clinical and therapeutic features of perianal disease were recorded. An adjusted time-dependent Cox model was used to evaluate the risk of evolution of anal ulcerations towards suppurative lesions. Results: Among the 1,005 included patients (females, 450 (44.8%); median age at diagnosis 14.4 years (IQR, 12.0-16.1)), 257 (25.6%) had an anal ulceration at diagnosis. Cumulative incidence of anal ulceration at 5 and 10 years from diagnosis was 38.4% (CI95%, 35.2-41.4) and 44.0% (CI95%, 40.5-47.2), respectively. In multivariable analysis, the presence of extra-intestinal manifestations (Hazard Ratio (HR) 1.46, CI95% 1.19-1.80, p=0.0003) and upper digestive location (HR 1.51, CI95% 1.23-1.86, p<0.0001) at diagnosis were associated with the occurrence of anal ulceration. Conversely, ileal location (L1) was associated with a lower risk of anal ulceration (L2 vs L1 HR 1.51, CI95% 1.11-2.06, p=0.0087; L3 vs L1 HR 1.42, CI95% 1.08-1.85, p=0.0116). The risk of fistulizing perianal CD was doubled in patients with a history of anal ulceration (HR 2.00, CI95% 1.45-2.74, p<0.0001). Among the 352 patients with at least one episode of anal ulceration without history of fistulizing perianal CD, 82 (23.3%) developed fistulizing perianal CD after a median follow-up of 5.7 years (IQR, 2.8-10.6). In these patients with anal ulceration, the diagnostic period (pre vs biologic era), exposure to immunosuppressants and/or anti-TNF did not influence the risk of secondary anoperineal suppuration. Conclusion: Anal ulceration is frequent in pediatric-onset CD, with nearly half of patients presenting with at least one episode after 10 years of evolution. Fistulizing perianal CD is twice as frequent in patients with present or past anal ulceration.Lire moins >

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
CHU Lille
Institut Pasteur de Lille

Collections :

• IMPact de l'Environnement Chimique sur la Santé humaine (IMPECS) - ULR 4483

Date de dépôt :

2023-10-20T05:49:18Z
2024-02-23T11:03:32Z