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Predicting Outcomes in Pediatric Crohn's Disease for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease-Ahead Program
A. Ricciuto, M. Aardoom, E. Orlanski-Meyer, D. Navon, N. Carman, M. Aloi, J. Bronsky, J. Däbritz, M. Dubinsky, S. Hussey, P. Lewindon, J. Martín De Carpi, VM. Navas-López, M. Orsi, FM. Ruemmele, RK. Russell, G. Veres, TD. Walters, DC. Wilson, T....
Language English Country United States
Document type Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
- MeSH
- Crohn Disease diagnosis therapy MeSH
- Child MeSH
- Outcome Assessment, Health Care MeSH
- Infant MeSH
- Consensus MeSH
- Humans MeSH
- Adolescent MeSH
- Infant, Newborn MeSH
- Predictive Value of Tests MeSH
- Child, Preschool MeSH
- Prognosis MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Infant, Newborn MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Research Support, Non-U.S. Gov't MeSH
- Systematic Review MeSH
BACKGROUND & AIMS: A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. METHODS: A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. RESULTS: Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. CONCLUSIONS: These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.
Department of General Pediatrics University Hospital Münster Germany
Department of Pediatrics University Hospital Motol Prague Czech Republic
Erasmus Medical Center Sophia Children's Hospital Rotterdam the Netherlands
IBD Centre SickKids Hospital University of Toronto Toronto Canada
Pediatric Gastroenterology and Nutrition Unit Hospital Regional Universitario de Málaga Spain
Pediatric Gastroenterology Unit Sapienza University of Rome Umberto 1 Hospital Rome Italy
Pediatric Institute Clinic University of Debrecen Hungary
University Medical Center Rostock Department of Pediatrics Rostock Germany
References provided by Crossref.org
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