P98 Disease involution is common among paediatric Crohn’s disease patients: a study from the biologic era
Notice bibliographique
Résumé
<h3>Introduction</h3> Paediatric Crohn’s disease (PCD) often presents with a pan-enteric phenotype at diagnosis. However, its long-term evolution in to adulthood, especially since the advent of biological therapy, is not well characterised. Only few studies have assessed this change, with conflicting results and limited by short follow-up times. Our study aimed to evaluate how the PCD phenotype evolves through childhood into adult life. <h3>Methods</h3> We performed a single-centre retrospective study of PCD patients diagnosed ≤16 years of age, transitioned to an adult gastroenterology unit with a minimum follow up of 2 years. Disease location and behaviour was characterised using Paris and Montreal classification at diagnosis and follow-up respectively. We assessed for evidence of disease extension or involution as well as variables associated with complicated disease behaviour and surgery. Comparison of frequencies was performed using Pearson’s chi-square test. Hazard ratios from Cox proportional hazards models were used to quantify risk of surgery and complicated disease behaviour. <h3>Results</h3> 132 patients were included, transitioning to adult care between 2002 and 2016. The median age at diagnosis was 13 (IQR 11–14) and median follow up 11 years. At diagnosis, 27 (20.4%) patients had complicated disease behaviour compared to 46 (34.9%) at follow up (p=0.0018). 83 (62.9%) patients had a ‘pan-enteric’ phenotype at diagnosis, however only 55 (66.3%) retained this phenotype at follow-up (p=0.0002). Disease extension was noted in 18.9% of patients and involution in 35.6% of patients, with upper GI disease noted in only 15.9% of patients at follow-up (p=0.0001). There was a high exposure to both thiopurines (91.7%) and biologics (63.6%), with a median time to starting treatment of 0 (IQR 0–1) and 5 (IQR 2–7) years for thiopurines and anti-TNF therapy respectively. The rate of exposure to biological therapy was similar in patients with disease involution (32/47, 68.1%) and disease extension (21/25, 84%). The cumulative probability (95% CI) of surgery was 0.05 (0.02, 0.11) at 1 year, 0.17 (0.11, 0.24) at 3 years and 0.22 (0.15, 0.30) at 5 years respectively. Overall, 56 (42.4%) patients had surgery at the end of follow-up. Neither disease location nor behaviour were associated with need for surgery. <h3>Conclusions</h3> Changes in both disease location and behaviour were seen in our PCD cohort as they progressed to adult life. A significant proportion had disease involution, likely related to a high rate of exposure to biological therapy.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».