Clinical Features and Extraintestinal Manifestations of Crohn Disease in Children
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Purpose: The aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients.Methods: The medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding base-line demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classi-fication, and clinical features and course of EIMs were investigated.Results: Fifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean fol-low-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileoco-lonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary throm-boembolism in 1 (1.4%). Conclusion: Perianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD.
Abstract
Purpose: The aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients.Methods: The medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding base-line demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classi-fication, and clinical features and course of EIMs were investigated.Results: Fifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean fol-low-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileoco-lonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary throm-boembolism in 1 (1.4%). Conclusion: Perianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD.
참고문헌 (29)
- Goodhand J, "Adolescents with IBD: the importance of structured transition care", J Crohns Colitis, 5, pp.509~519 (2011)
- Benchimol EI, "Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends", Inflamm Bowel Dis, 17, pp.423~439 (2011)
- Müller KE, "Incidence, Paris classification, and follow- up in a nationwide incident cohort of pediatric patients with inflammatory bowel disease", J Pediatr Gastroenterol Nutr, 57, pp.576~582 (2013)
- Veloso FT, "Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients", J Clin Gastroenterol, 23, pp.29~34 (1996)
- Rothfuss KS, "Extraintestinal manifestations and complications in inflammatory bowel diseases", World J Gastroenterol, 12, pp.4819~4831 (2006)
- Veloso FT, "Extraintestinal manifestations of inflammatory bowel disease: do they influence treatment and outcome", World J Gastroenterol, 17, pp.2702~2707 (2011)
- Mamula P, "Inflammatory bowel disease in early childhood and adolescence: special considerations", Gastroenterol Clin North Am, 32, pp.967~995 (2003)
- Seo JK, "Inflammatory bowel disease in children--clinical, endoscopic, radiologic and histopathologic investigation", J Korean Med Sci, 7, pp.221~235 (1992)
- 이나영, "소아 크론병의 임상적 특징과 경과", Clinical Endoscopy, 34(4), pp.193~199 (2007), 대한소화기내시경학회
- Kim BJ, "Characteristics and trends in the incidence of inflammatory bowel disease in Korean children: a single- center experience", Dig Dis Sci, 55, pp.1989~1995 (2010)
- Silverberg MS, "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 montreal world congress of gastroenterology", Can J Gastroenterol, 19(Suppl A), pp.5A~36A (2005)
- Ye BD, "Clinical features and long-term prognosis of Crohn's disease in Korea", Scand J Gastroenterol, 45, pp.1178~1185 (2010)
- Spray C, "Current diagnosis, management and morbidity in paediatric inflammatory bowel disease", Acta Paediatr, 90, pp.400~405 (2001)
- Sawczenko A, "Presenting features of inflammatory bowel disease in Great Britain and Ireland", Arch Dis Child, 88, pp.995~1000 (2003)
- Kugathasan S, "Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study", J Pediatr, 143, pp.525~531 (2003)
- de Bie CI, "Disease phenotype at diagnosis in pediatric Crohn's disease: 5-year analyses of the EUROKIDS registry", Inflamm Bowel Dis, 19, pp.378~385 (2013)
- Palder SB, "Perianal complications of pediatric Crohn's disease", J Pediatr Surg, 26, pp.513~515 (1991)
- Korelitz BI, "Anal skin tags: an overlooked indicator of Crohn's disease", J Clin Gastroenterol, 44, pp.151~152 (2010)
- Taylor BA, "The histology of anal skin tags in Crohn's disease: an aid to confirmation of the diagnosis", Int J Colorectal Dis, 4, pp.197~199 (1989)
- Dotson JL, "Extraintestinal manifestations of pediatric inflammatory bowel disease and their relation to disease type and severity", J Pediatr Gastroenterol Nutr, 51, pp.140~145 (2010)
- Veloso FT, "Clinical outcome of Crohn's disease: analysis according to the vienna classification and clinical activity", Inflamm Bowel Dis, 7, pp.306~313 (2001)
- Seibold F, "Autoimmune hepatitis in inflammatory bowel disease: report of two unusual cases", Z Gastroenterol, 35, pp.29~32 (1997)
- Uko V, "Liver disorders in inflammatory bowel disease", Gastroenterol Res Pract, 2012, pp.642923~ (2012)
- Schatorjé E, "Transient hypertransaminasemia in paediatric patients with Crohn disease undergoing initial treatment with enteral nutrition", J Pediatr Gastroenterol Nutr, 51, pp.336~340 (2010)
- Lemberg DA, "Transient hypertransaminasemia in pediatric patients with Crohn disease", J Pediatr Gastroenterol Nutr, 53, pp.229~ (2011)
- Sonoda K, "Evaluation of venous thromboembolism and coagulation- fibrinolysis markers in Japanese patients with inflammatory bowel disease", J Gastroenterol, 39, pp.948~954 (2004)
- Guerra Montero LJ, "Clinical characteristics of patients with inflammatory bowel disease and thromboembolic events", Acta Gastroenterol Latinoam, 40, pp.134~141 (2010)
- Lazzerini M, "Thromboembolism in pediatric inflammatory bowel disease: systematic review", Inflamm Bowel Dis, 17, pp.2174~2183 (2011)
- Nylund CM, "Venous thrombotic events in hospitalized children and adolescents with inflammatory bowel disease", J Pediatr Gastroenterol Nutr, 56, pp.485~491 (2013)