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http://dx.doi.org/10.5223/pghn.2020.23.1.49

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts  

Kang, Ben (Department of Pediatrics, School of Medicine, Kyungpook National University)
Kim, Jung Eun (Department of Pediatrics, School of Medicine, Kyungpook National University)
Jung, Jae Hun (Department of Pediatrics, School of Medicine, Kyungpook National University)
Choe, Jae Young (Department of Emergency Medicine, School of Medicine, Kyungpook National University)
Kim, Mi Jin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Choe, Yon Ho (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Kim, Seung (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Koh, Hong (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Lee, Yoo Min (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine)
Lee, Jee Hyun (Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine)
Lee, Yoon (Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine)
Lee, Ji-Hyuk (Department of Pediatrics, Chungbuk National University College of Medicine)
Lee, Hae Jeong (Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Jang, Hyo-Jeong (Crohn's and Colitis Association in Daegu-Gyeongbuk (CCAiD))
Choi, Youjin (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine)
Choi, So Yoon (Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine)
Kim, Ju Young (Department of Pediatrics, Eulji University School of Medicine)
Choe, Byung-Ho (Department of Pediatrics, School of Medicine, Kyungpook National University)
Publication Information
Pediatric Gastroenterology, Hepatology & Nutrition / v.23, no.1, 2020 , pp. 49-62 More about this Journal
Abstract
Purpose: We aimed to investigate the disease phenotype of Korean pediatric Crohn's disease (CD) patients at diagnosis according to the Paris classification by comparison with patients from the European multicenter 5-years recruitment of children with newly developed IBD (EUROKIDS registry). Methods: Korean children and adolescents who had been newly diagnosed with CD at the age of <18 years during 2013-2016 were included in this multicenter retrospective study. Disease phenotype at diagnosis was classified according to the Paris classification, and compared with the published data from the EUROKIDS study. Results: A total of 255 patients were included. The median diagnosis age was 14.7 years (range, 0.8-17.9 years). No significant difference was observed in male-to-female ratio with EUROKIDS (1.9:1 vs. 1.45:1, p=0.062). The proportion of children aged <10 years was significantly lower in Koreans (7.1% vs. 19.6%, p<0.001). Colonic disease was less prominent (10.0% vs. 27.3%, p<0.001), while upper GI involvement was more prominent in Korean children (59.3% vs. 46.2%, p<0.001). The proportion with perianal fistulizing disease at diagnosis was significantly higher in Korean patients (44.8% vs. 8.2%, p<0.001). A separate analysis of Korean patients revealed that perianal fistulizing disease at diagnosis was positively associated with male sex and body mass index z-score (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.20-3.76, p=0.010; and OR=1.29, 95% CI=1.05-1.58, p=0.015, respectively). Conclusion: Approximately half of pediatric CD patients in Korea present with perianal fistulas and/or abscesses at diagnosis, which is a distinct feature of CD in Korean children and adolescents compared to their European counterparts. An underlying genetic difference between ethnicities may play a role in this expression of different phenotypes in pediatric CD.
Keywords
Crohn disease; Fistula; Abscess; Paris; Classification; Phenotype; Korea; Europe; Pediatrics; Inflammatory bowel disease;
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1 Attard TM, Horton KM, DeVito K, Darbari A, Oliva-Hemker M, Thompson R, Cuffari C Pediatric jejunoileitis: a severe Crohn's disease phenotype that requires intensive nutritional management. Inflamm Bowel Dis 2004;10:357-60.   DOI
2 Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis 2002;8:244-50.   DOI
3 Walters TD, Kim MO, Denson LA, Griffiths AM, Dubinsky M, Markowitz J, et al.; PRO-KIIDS Research Group. Increased effectiveness of early therapy with anti-tumor necrosis factor-${\alpha}$ vs an immunomodulator in children with Crohn's disease. Gastroenterology 2014;146:383-91.   DOI
4 Kang B, Choi SY, Kim HS, Kim K, Lee YM, Choe YH. Mucosal healing in paediatric patients with moderate-to-severe luminal Crohn's disease under combined immunosuppression: escalation versus early treatment. J Crohn's Colitis 2016;10:1279-86.   DOI
5 Choi J, Kang B, Kim MJ, Sohn I, Lee HJ, Choe YH. Early infliximab yields superior long-term effects on linear growth in pediatric Crohn's disease patients. Gut Liver 2018;12:255-62.   DOI
6 Bouguen G, Levesque BG, Feagan BG, Kavanaugh A, Peyrin-Biroulet L, Colombel JF, et al. Treat to target: a proposed new paradigm for the management of Crohn's disease. Clin Gastroenterol Hepatol 2015;13:1042-50.e2.   DOI
7 Kang B, Choe YH. Early biologic treatment in pediatric Crohn's disease: catching the therapeutic window of opportunity in early disease by treat-to-target. Pediatr Gastroenterol Hepatol Nutr 2018;21:1-11.   DOI
8 Birimberg-Schwartz L, Zucker DM, Akriv A, Cucchiara S, Cameron FL, Wilson DC, et al.; Pediatric IBD Porto group of ESPGHAN. Development and validation of diagnostic criteria for IBD subtypes including IBD-unclassified in children: a multicentre study from the Pediatric IBD Porto Group of ESPGHAN. J Crohn's Colitis 2017;11:1078-84.
9 Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr 2015;169:1053-60.   DOI
10 Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007;369:1641-57.   DOI
11 Sykora J, Pomahacova R, Kreslova M, Cvalinova D, Stych P, Schwarz J. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol 2018;24:2741-63.   DOI
12 Ashton JJ, Cullen M, Afzal NA, Coelho T, Batra A, Beattie RM. Is the incidence of paediatric inflammatory bowel disease still increasing? Arch Dis Child 2018;103:1093-4.   DOI
13 Ghersin I, Khteeb N, Katz LH, Daher S, Shamir R, Assa A. Trends in the epidemiology of inflammatory bowel disease among Jewish Israeli adolescents: a population-based study. Aliment Pharmacol Ther 2019;49:556-63.   DOI
14 Kaplan GG, Ng SC. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 2017;152:313-21.e2.   DOI
15 Kang B, Lee Y, Lee K, Choi YO, Choe YH. Long-term outcomes after switching to CT-P13 in pediatric-onset inflammatory bowel disease: a single-center prospective observational study. Inflamm Bowel Dis 2018;24:607-16.   DOI
16 Jung YS, Han M, Kim WH, Park S, Cheon JH. Incidence and clinical outcomes of inflammatory bowel disease in South Korea, 2011-2014: a nationwide population-based study. Dig Dis Sci 2017;62:2102-12.   DOI
17 Hong SJ, Cho SM, Choe BH, Jang HJ, Choi KH, Kang B, et al. Characteristics and incidence trends for pediatric inflammatory bowel disease in Daegu-Kyungpook province in Korea: a multi-center study. J Korean Med Sci 2018;33:e132.   DOI
18 Shi HY, Levy AN, Trivedi HD, Chan FKL, Ng SC, Ananthakrishnan AN. Ethnicity influences phenotype and outcomes in inflammatory bowel disease: a systematic review and meta-analysis of population-based studies. Clin Gastroenterol Hepatol 2018;16:190-7.e11.   DOI
19 Kim BJ, Song SM, Kim KM, Lee YJ, Rhee KW, Jang JY, et al. Characteristics and trends in the incidence of inflammatory bowel disease in Korean children: a single-center experience. Dig Dis Sci 2010;55:1989-95.   DOI
20 Jin WS, Park JH, Lim KI, Tchah H, Ryoo E. Significance of perianal lesion in pediatric crohn disease. Pediatr Gastroenterol Hepatol Nutr 2018;21:184-8.   DOI
21 Kang B, Choi SY, Choi YO, Kim MJ, Kim K, Lee JH, et al. Subtherapeutic infliximab trough levels and complete mucosal healing are associated with sustained clinical remission after infliximab cessation in paediatric-onset Crohn's disease patients treated with combined immunosuppressive therapy. J Crohn's Colitis 2018;12:644-52.   DOI
22 Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al.; European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014;58:795-806.   DOI
23 Kang B, Choi SY, Choi YO, Lee SY, Baek SY, Sohn I, et al. Infliximab trough levels are associated with mucosal healing during maintenance treatment with infliximab in paediatric Crohn's disease. J Crohn's Colitis 2019;13:189-97.   DOI
24 Assa A, Amitai M, Greer ML, Castro DA, Kuint RC, Martinez-Leon M, et al.; ImageKids Study Group. Perianal pediatric crohn disease is associated with a distinct phenotype and greater inflammatory burden. J Pediatr Gastroenterol Nutr 2017;65:293-8.   DOI
25 Adler J, Dong S, Eder SJ, Dombkowski KJ; ImproveCareNow Pediatric IBD Learning Health System. Perianal crohn disease in a large multicenter pediatric collaborative. J Pediatr Gastroenterol Nutr 2017;64:e117-24.   DOI
26 Lee HA, Suk JY, Choi SY, Kim ER, Kim YH, Lee CK, et al. Characteristics of pediatric inflammatory bowel disease in Korea: comparison with EUROKIDS data. Gut Liver 2015;9:756-60.   DOI
27 de Bie CI, Paerregaard A, Kolacek S, Ruemmele FM, Koletzko S, Fell JM, et al.; EUROKIDS Porto IBD Working Group of ESPGHAN. Disease phenotype at diagnosis in pediatric Crohn's disease: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis 2013;19:378-85.   DOI
28 Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 2011;17:1314-21.   DOI
29 Short SS, Dubinsky MC, Rabizadeh S, Farrior S, Berel D, Frykman PK. Distinct phenotypes of children with perianal perforating Crohn's disease. J Pediatr Surg 2013;48:1301-5.   DOI
30 Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al.; Committee for the Development of Growth Standards for Korean Children and Adolescents; Committee for School Health and Public Health Statistics, the Korean Pediatric Society; Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr 2018;61:135-49.   DOI
31 Lophaven SN, Lynge E, Burisch J. The incidence of inflammatory bowel disease in Denmark 1980-2013: a nationwide cohort study. Aliment Pharmacol Ther 2017;45:961-72.   DOI
32 Everhov AH, Olen O, Ludvigsson JF. Editorial: importance of definition of inflammatory bowel disease and an increased incidence in children. Aliment Pharmacol Ther 2017;45:1369-70.   DOI
33 Duricova D, Fumery M, Annese V, Lakatos PL, Peyrin-Biroulet L, Gower-Rousseau C. The natural history of Crohn's disease in children: a review of population-based studies. Eur J Gastroenterol Hepatol 2017;29:125-34.   DOI
34 Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV Jr. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol 2017;15:857-63.   DOI
35 Benchimol EI, Manuel DG, Guttmann A, Nguyen GC, Mojaverian N, Quach P, et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis 2014;20:1761-9.   DOI
36 Shah SC, Khalili H, Gower-Rousseau C, Olen O, Benchimol EI, Lynge E, et al. Sex-based differences in incidence of inflammatory bowel diseases-pooled analysis of population-based studies from Western Countries. Gastroenterology 2018;155:1079-89.e3.   DOI
37 Shah SC, Khalili H, Chen CY, Ahn HS, Ng SC, Burisch J, et al. Sex-based differences in the incidence of inflammatory bowel diseases-pooled analysis of population-based studies from the Asia-Pacific region. Aliment Pharmacol Ther 2019;49:904-11.   DOI
38 Park SH, Kim YJ, Rhee KH, Kim YH, Hong SN, Kim KH, et al.; Songpa-Kangdong Inflammatory Bowel Disease [SK-IBD] Study Group. A 30-year trend analysis in the epidemiology of inflammatory bowel disease in the Songpa-Kangdong district of Seoul, Korea in 1986-2015. J Crohn's Colitis 2019;13:1410-7.   DOI
39 Van Limbergen J, Russell RK, Drummond HE, Aldhous MC, Round NK, Nimmo ER, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 2008;135:1114-22.   DOI
40 Kim HJ, Oh SH, Kim DY, Lee HS, Park SH, Yang SK, et al. Clinical characteristics and long-term outcomes of paediatric Crohn's disease: a single-centre experience. J Crohn's Colitis 2017;11:157-64.   DOI