Guidance Focuses on Pediatric Crohn Disease Outcome Predictors

The international Pediatric Inflammatory Bowel Disease Ahead Program (PIBD-Ahead) has developed 27 consensus statements that offer insight into predictors of poor outcomes among patients with pediatric Crohn disease (CD).

“A better understanding of prognostic factors within the heterogeneous spectrum of pediatric CD should improve patient management and reduce complications,” the authors wrote. “We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management.”

The researchers surveyed 202 practicing pediatric gastroenterologists from 33 countries to prioritize pediatric CD outcomes that should be avoided. Next, they performed a systematic review with meta-analysis, when possible, to identify predictors of those outcomes. Consensus statements based on published evidence were drafted at in-person national and international meetings. At a final meeting in February 2018, statements were accepted if 80% or more participants agreed with the content.

The resulting 27 consensus statements address prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. 

According to the statements, diagnosis during adolescence, growth impairment, and disease location may predict increased risk of surgery. Isolated colonic disease, however, is linked with fewer surgeries.

Risk factors for penetrating (B3) and/or stenotic disease (B2) include older age at presentation, ethnicity/race, small bowel disease, and perianal disease. Meanwhile, growth impairment appears to be associated with being a boy, being a younger age at onset, and having small bowel disease. Malnutrition and higher clinical disease activity signal a possibility of low bone density.

“Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD to evaluate the impact of treatment algorithms tailored to individual patient risk,” the researchers concluded.

—Jolynn Tumolo

Reference:

Ricciuto A, Aardoom M, Orlanski-Meyer E, et al. Predicting outcomes in pediatric Crohn’s disease for management optimization: systematic review and consensus statements from the Pediatric Inflammatory Bowel Disease-Ahead Program. Gastroenterology. 2021;160(1):403-436.e26. doi:10.1053/j.gastro.2020.07.065