Yenny Kho
Justus-Liebig-Universität Gießen Zentrum für Kinderheilkunde und Jugendmedizin, Abteilung für Allgemeinpädiatrie und Neonatologie
Edition scientifique ISSN: 1-6 978-3-8359-6482-2
Summary
In the latest consensus guidelines (ECCO/ESPGHAN) of medical management of Pediatric Crohn’s disease, there are seven factors to be considered as potential Predictors of Poor Outcomes (POPO). These are: deep colonic ulcerations on endoscopy, persistent severe disease, despite adequate induction therapy, extensive (pan-enteric) disease, marked growth retardation, severe osteoporosis, stricturing and penetrating disease and severe perianal disease. This study has analysed five of the seven factors from large Pediatric Data from German’s register for Inflammatory Bowel Disease (IBD) (CEDATA-GPGE)
About 72% of the patients showed at least one of the five analysed POPO-factors (POPO-positive). This group of patients were significantly younger and had higher PCDAI-Scores than the POPO-negative group. At the time of diagnosis most of the initial symptoms were often: stomach ache, weight stagnation, growth problems, fever, anemia, fatigue, lost of appetite and extraintestinal manifestations
Initially during the first year, the POPO-positive patients were more often treated with Corticosteroids, 5-ASA, immunomodulators, anti-TNF-α, antibiotic and exclusive enteral nutrition, than the POPO-negative patients. It has also shown that the POPO-positive patients benefit more from early treatment with immunomodulator Azathioprine.
All patients who are treated early with immunomodulators, within three months after diagnosis, appear to benefit more and have significantly better outcomes compared to those who are not.
This study confirms that certain factors, that are mentioned by ECCO/ESPHGAN, can be used as predictors of poor outcomes of Pediatric Crohn’s disease. They show a positive predictive value of more than 70%. Patients, who are showing at least one of the factors mentioned above tend to have a poor outcome and should be treated earlier with immunomodulators.