Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts
2
조회
0
다운로드
11
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (40)
- Baumgart DC, "Inflammatory bowel disease : clinical aspects and established and evolving therapies", Lancet, 369, pp.1641~1657 (2007)
- Rosen MJ, "Inflammatory bowel disease in children and adolescents", JAMA Pediatr, 169, pp.1053~1060 (2015)
- Sýkora J, "Current global trends in the incidence of pediatric-onset inflammatory bowel disease", World J Gastroenterol, 24, pp.2741~2763 (2018)
- Ashton JJ, "Is the incidence of paediatric inflammatory bowel disease still increasing", Arch Dis Child, 103, pp.1093~1094 (2018)
- Ghersin I, "Trends in the epidemiology of inflammatory bowel disease among Jewish Israeli adolescents : a population-based study", Aliment Pharmacol Ther, 49, pp.556~563 (2019)
- Kaplan GG, "Understanding and preventing the global increase of inflammatory bowel disease", Gastroenterology, 152, pp.313~321 (2017)
- Jung YS, "Incidence and clinical outcomes of inflammatory bowel disease in South Korea, 2011-2014 : a nationwide population-based study", Dig Dis Sci, 62, pp.2102~2112 (2017)
- 홍석진, "Characteristics and Incidence Trends for Pediatric Inflammatory Bowel Disease in Daegu-Kyungpook Province in Korea: a Multi-Center Study", Journal of Korean Medical Science, 33(18), pp.1~8 (2018), 대한의학회
- Hyeon Ah Lee, "Characteristics of Pediatric Inflammatory Bowel Disease in Korea: Comparison with EUROKIDS Data", Gut and Liver, 9(6), pp.756~760 (2015), 거트앤리버 소화기연관학회협의회
- 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)
- Levine A, "ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents", J Pediatr Gastroenterol Nutr, 58, pp.795~806 (2014)
- 김재현, "The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects", Clinical and Experimental Pediatrics, 61(5), pp.135~149 (2018), 대한소아청소년과학회
- Levine A, "Pediatric modification of the Montreal classification for inflammatory bowel disease : the Paris classification", Inflamm Bowel Dis, 17, pp.1314~1321 (2011)
- Lophaven SN, "The incidence of inflammatory bowel disease in Denmark 1980-2013 : a nationwide cohort study", Aliment Pharmacol Ther, 45, pp.961~972 (2017)
- Everhov ÅH, "Editorial : importance of definition of inflammatory bowel disease and an increased incidence in children", Aliment Pharmacol Ther, 45, pp.1369~1370 (2017)
- Shivashankar R, "Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010", Clin Gastroenterol Hepatol, 15, pp.857~863 (2017)
- Benchimol EI, "Changing age demographics of inflammatory bowel disease in Ontario, Canada : a population-based cohort study of epidemiology trends", Inflamm Bowel Dis, 20, pp.1761~1769 (2014)
- Shah SC, "Sex-based differences in incidence of inflammatory bowel diseases-pooled analysis of population-based studies from Western Countries", Gastroenterology, 155, pp.1079~1089 (2018)
- Shah SC, "Sex-based differences in the incidence of inflammatory bowel diseases-pooled analysis of population-based studies from the Asia-Pacific region", Aliment Pharmacol Ther, 49, pp.904~911 (2019)
- Park SH, "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, 13, pp.1410~1417 (2019)
- Duricova D, "The natural history of Crohn's disease in children : a review of population-based studies", Eur J Gastroenterol Hepatol, 29, pp.125~134 (2017)
- Van Limbergen J, "Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease", Gastroenterology, 135, pp.1114~1122 (2008)
- Kim HJ, "Clinical characteristics and long-term outcomes of paediatric Crohn's disease : a single-centre experience", J Crohn's Colitis, 11, pp.157~164 (2017)
- Attard TM, "Pediatric jejunoileitis: a severe Crohn's disease phenotype that requires intensive nutritional management", Inflamm Bowel Dis, 10, pp.357~360 (2004)
- Cosnes J, "Long-term evolution of disease behavior of Crohn's disease", Inflamm Bowel Dis, 8, pp.244~250 (2002)
- Walters TD, "Increased effectiveness of early therapy with anti-tumor necrosis factor-α vs an immunomodulator in children with Crohn's disease", Gastroenterology, 146, pp.383~391 (2014)
- Kang B, "Mucosal healing in paediatric patients with moderate-to-severe luminal Crohn's disease under combined immunosuppression : escalation versus early treatment", J Crohn's Colitis, 10, pp.1279~1286 (2016)
- Jaeyoung Choi, "Early Infliximab Yields Superior Long-Term Effects on Linear Growth in Pediatric Crohn’s Disease Patients", Gut and Liver, 12(3), pp.255~262 (2018), 거트앤리버 소화기연관학회협의회
- Bouguen G, "Treat to target : a proposed new paradigm for the management of Crohn's disease", Clin Gastroenterol Hepatol, 13, pp.1042~1050 (2015)
- Ben Kang, "Early Biologic Treatment in Pediatric Crohn’s Disease: Catchingthe Therapeutic Window of Opportunity in Early Disease by Treat-to-Target", Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), pp.1~11 (2018), 대한소아소화기영양학회
- Birimberg-Schwartz L, "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, 11, pp.1078~1084 (2017)
- Shi HY, "Ethnicity influences phenotype and outcomes in inflammatory bowel disease : a systematic review and meta-analysis of population-based studies", Clin Gastroenterol Hepatol, 16, pp.190~197 (2018)
- 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)
- Won Seok Jin, "Significance of Perianal Lesion in Pediatric Crohn Disease", Pediatric Gastroenterology, Hepatology & Nutrition, 21(3), pp.184~188 (2018), 대한소아소화기영양학회
- Kang B, "Long-term outcomes after switching to CT-P13 in pediatric-onset inflammatory bowel disease : a single-center prospective observational study", Inflamm Bowel Dis, 24, pp.607~616 (2018)
- Kang B, "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, 12, pp.644~652 (2018)
- Kang B, "Infliximab trough levels are associated with mucosal healing during maintenance treatment with infliximab in paediatric Crohn's disease", J Crohn's Colitis, 13, pp.189~197 (2019)
- Assa A, "Perianal pediatric crohn disease is associated with a distinct phenotype and greater inflammatory burden", J Pediatr Gastroenterol Nutr, 65, pp.293~298 (2017)
- Adler J, "Perianal crohn disease in a large multicenter pediatric collaborative", J Pediatr Gastroenterol Nutr, 64, pp.e117~24 (2017)
- Short SS, "Distinct phenotypes of children with perianal perforating Crohn's disease", J Pediatr Surg, 48, pp.1301~1305 (2013)