Pediatric Crohn's disease from onset to adulthood: granulomas are associated with an early need for immunomodulation. (August 2014)

• Record Type: Journal Article
• Authors: Ideström, Maja; Rubio, Carlos A.; Onelöv, Erik; Henter, Jan-Inge; Fagerberg, Ulrika L.; Finkel, Yigael
• Is Part Of: Scandinavian journal of gastroenterology. Volume 49:Number 8(2014)
• Page Start: 950
• Page End: 957
• Publication Date: 2014-08
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2014.920911
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Objective.</italic> </bold> 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. <bold><italic>Material and methods.</italic></bold> Forty<italic>-</italic>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. <bold><italic>Results.</italic></bold> 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%) (<italic>p</italic> = 0.017 and <italic>p</italic> = 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; <italic>p</italic> = 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. <bold><italic>Conclusions.</italic></bold> 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.</p> </abstract>