Long-Term Outcome of Colonic and Ileal Crohn's Disease: A Two-Decade Population-Based Study in Pediatric-Onset Disease

Mathurin Fumery; Guillaume Savoye; Hélène Sarter; Claire Dupont-Lucas; Valérie Bertrand; Pauline Wils; Nicolas Richard; Nathalie Guillon; Corinne Gower-Rousseau; Dominique Turck; Delphine Ley; Ariane Leroyer; EPIMAD group

doi:10.1093/ibd/izaf133

Long-Term Outcome of Colonic and Ileal Crohn's Disease: A Two-Decade Population-Based Study in Pediatric-Onset Disease

Inflamm Bowel Dis. 2025 Jun 25:izaf133. doi: 10.1093/ibd/izaf133. Online ahead of print.

Authors

Mathurin Fumery¹, Guillaume Savoye², Hélène Sarter^{3

4}, Claire Dupont-Lucas⁵, Valérie Bertrand⁶, Pauline Wils³, Nicolas Richard², Nathalie Guillon^{3

4}, Corinne Gower-Rousseau⁷, Dominique Turck^{3

8}, Delphine Ley^{3

8}, Ariane Leroyer^{3

4}; EPIMAD group

Collaborators

EPIMAD group:
R Al Khatib, M Al Turk, S Agoute, E Andre, J M Antonietti, M Aouakli, A Armand, A Armengol-Debeir, L Aroichane, I Assi, F Aubet, J P Auxenfants, E Avram, A Ayafi-Ramelot, F Azzouzi, K Bankovski, D Barbry, B Bardoux, N Baron, P Baudet, A Bayart, P Bazin, B Bebahani, A Becqwort, J P Bellati, S Benet, V Benali, H Benard, C Benguigui, C Ben Soussan, E Bental, A Berkelmans, I Bernet, J Bernou, K Bernou-Dron, C Bertot, P Bertiaux-Vandaële, N Bertrand, V Billoud, E Biron, N Bismuth, B Bleuet, M Blondel, F Blondin, V Bobula, M Bohon, P Bondjemah, V Boniface, E Bonkovski, D Bonnière, P Bonvarlet, E Bonvarlet, P Boruchowicz, A Bostvironnois, R Boualit, M Bouazza, A Bouche, B Boudaillez, C Bourgeaux, C Bourgeois, M Bourguet, A Bourienne, A Boutaleb, H Bouthors, A Branche, J Bray, G Brazier, F Breban, P Bridenne, M Brihier, H Bril, L Brung-Lefebvre, V Bulois, P Burgiere, P Butel, J Canva, J Y Canva-Delcambre, V Capron, J P Cardot, F Carette, S Carpentier, P Cartier, E Cassar, J F Cassagnou, M Castex, J F Catala, P Cattan, S Catteau, S Caujolle, B Cayron, G Chandelier, C Chantre, M Charles, J Charneau, T Chavance-Thelu, M Cheny, A Chirita, D Choteau, A Claerbout, J F Clergue, P Y Coevoet, H Cohen, G Collet, R Colin, M Colombel, J F Coopman, S Cordiez, L Corvisart, J Cortot, A Couttenier, F Crinquette, J F Crombe, V Dadamessi, I Daoudi, H Dapvril, V Davion, T Dautreme, S Debas, J Decoster, S Degrave, N Dehont, F Delatre, C Delcenserie, R Delesalle, D Delette, O Delgrange, T Delhoustal, L Delmotte, J S Demmane, S Deregnaucourt, G Descombes, P Desechalliers, J P Desmet, P Desreumaux, P Desseaux, G Desurmont, P Devienne, A Devouge, E Devred, M Devroux, A Dewailly, A Dharancy, S Di Fiore, A Djedir, D Djedir, R Doleh, W Dreher-Duwat, M L Dubois, R Duburque, C Ducatillon, P Duclay, J Ducrocq, B Ducrot, F Ducrotte, P Dufilho, A Duhamel, C Dujardin, D Dumant-Forest, C Dupas, J L Dupont, F Duranton, Y Duriez, A Duveau, N El Achkar, K El Farisi, M Elie, C Elie-Legrand, M C Elkhaki, A Eoche, M Essmaeel, E Evrard, D Evrard, J P Fatome, A Filoche, B Finet, L Flahaut, M Flamme, C Foissey, D Fournier, P Foutrein-Comes, M C Foutrein, P Fremond, D Frere, T Fumery, M Gallais, P Gamblin, C Ganga, S Gerard, R Geslin, G Gheyssens, Y Ghossini, N Ghrib, S Gilbert, T Gillet, B Godart, D Godard, P Godchaux, J M Godchaux, R Goegebeur, G Goria, O Gottrand, F Gower, P Grandmaison, B Groux, M Guedon, C Guerbeau, L Gueroult-Dero, M Guillard, J F Guillem, L Guillemot, F Guimber, D Haddouche, B Hakim, S Hanon D Hautefeuille, V Heckestweiller, P Hecquet, G Hedde, J P Hellal, H Henneresse, P E Heyman, B Heraud, M Herve, S Hochain, P Houssin-Bailly, L Houcke, P Huguenin, B Iobagiu, S Istanboli, S Ivanovic, A Iwanicki-Caron, I Janicki, E Jarry, M Jeu, J Joly, J P Jonas, C Jouvenet, A Katherin, F Kerleveo, A Khachfe, A Kiriakos, A Kiriakos, J Klein, O Kohut, M Kornhauser, R Koutsomanis, D Laberenne, J E Lacotte, E Laffineur, G Lagarde, M Lalanne, A Lalieu, A Lannoy, P Lapchin, J Laprand, M Laude, D Leblanc, R Lecieux, P Lecleire, S Leclerc, N Le Couteulx, C Ledent, J Lefebvre, J Lefiliatre, P Le Goffic, C Legrand, C Le Grix, A Lelong, P Leluyer, B Lemaitre, C Lenaerts, C Lepeut, G Lepileur, L Leplat, A Lepoutre-Dujardin, E Leroi H Leroy, M Y Le Roy, P Lesage, B Lesage, J P Lesage, X Lesage, J Lescanne-Darchis, I Lescut, J Lescut, D Leurent, B Levy, P Ley, D Lhermie, M Libier, L Lion, A Lisambert, B Loge, I Loire, F Loreau, J Louf, S Louvet, A Lubret, L Luciani, M Lucidarme, D Lugand, J Macaigne, O Maetz, D Maillard, D Mancheron, H Manolache, O Marks-Brunel, A B Marre, C Marti, R Martin, F Martin, G Marzloff, E Mathurin, P Mauillon, J Maunoury, V Maupas, J L Medam Djomo, M A Mechior, C Melki, Z Mesnard, B Metayer, P Methari, L Meurisse, B Meurisse, F Michaud, L Mirmaran, X Modaine, P Monthe, A Morel, L Mortier, P E Moulin, E Mouterde, O Mozziconaci, N Mudry, J Nachury, M Ngo, M D N'Guyen Khac, E Notteghem, B Ollevier, V Ostyn, A Ouraghi, A Oussadou, B Ouvry, D Paillot, B Painchart, C Panien-Claudot, N Paoletti, C Papazian, A Parent, B Pariente, B Paris, J C Patrier, P Paupard, T Pauwels, B Pauwels, M Penninck, E Petit, R Piat, M Piotte, S Plane, C Plouvier, B Pollet, E Pommelet, P Pop, D Pordes, C Pouchain, G Prades, P Prevost, A Prevost, J C Quartier, G Quesnel, B Queuniet, A M Quinton, J F Rabache, A Rabelle, P Raclot, G Ratajczyk, S Rault, D Razemon, V Reix, N Renaut-Vantroys, T Revillion, M Riachi, G Richez, C Riault, C Robinson, P Rodriguez, J Roger, J Roux, J M Rudelli, A Saber, A Savoye, G Schlossberg, P Sefrioui, D Segrestin, M Seguy, D Seminur, C Serin, M Seryer, A Sevenet, F Shekh, N Silvie, J Simon, V Spyckerelle, C Talbodec, N Tavernier, N Tchandeu, H Techy, A Thelu, J L Thevenin, A Thiebault, H Thomas, J Thorel, J M Thuillier, C Tielman, G Tode, M Toisin, J Tonnel, J Touchais, J Y Toumelin, P Touze, Y Tranvouez, J L Triplet, C Triki, N Turck, D Uhlen, S Vaillant, E Valmage, C Vanco, D Vandaele-Bertiaux, N Vandamme, H Vanderbecq, E Vander Eecken, E Vandermolen, P Vandevenne, P Vandeville, L Vandewalle, A Vandewalle, C Vaneslander, P Vanhoove, J P Vanrenterghem, A Vanveuren, C Varlet, P Vasies, I Verbiese, G Verlynde, J Vernier-Massouille, G Vermelle, P Verne, C Vezilier-Cocq, P Vigneron, B Vincendet, M Viot, J Voiment, Y M Wacrenier, A Waeghemaecker, L Wallez, J Y Wantiez, M Wartel, F Weber, J Willocquet, J L Wizla, N Wolschies, E Zaharia, O Zaoui, S Zalar, A Zaouri, B Zellweger, A Ziade

Affiliations

¹ Gastroenterology Unit, Amiens University Hospital, and PeriTox, Université de Picardie Jules Verne, Amiens, France.
² Department of Gastroenterology, Univ Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and microbiota-gut-brain axis," CHU Rouen, F-76000 Rouen, France.
³ Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Univ. Lille, F-59000 Lille, France.
⁴ Department of Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille University Hospital, Lille, France in Inflammation, F-59000 Lille, France.
⁵ Department of Paediatrics, Gastroenterology, Caen University Hospital, Caen, France.
⁶ Department of Paediatrics, Le Havre Hospital, Le Havre, France.
⁷ Department of Epidemiology, Reims University Hospital, Reims, France.
⁸ Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, CHU Lille, F-59000 Lille, France.

PMID: 40556440
DOI: 10.1093/ibd/izaf133

Abstract

Introduction: Crohn's disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset inflammatory bowel disease (IBD).

Patients and methods: All children (<17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were included. The presentation at diagnosis, the risks of complications, surgery, hospitalization, and exposure to different treatments in ileal CD (CD-L1), colonic CD (CD-L2), and UC were compared.

Results: A total of 215 CD-L1 patients, 234 CD-L2 patients, and 337 UC patients were included. Over the study period, the annual incidence rates of CD-L1, CD-L2, and UC were 0.65 (95% CI, 0.57-0.74), 0.71 (0.62-0.81), and 1.02 (0.92-1.14) per 105 persons, respectively. At diagnosis, the proportion of males (L1 53%; L2 53%; UC 43%; P = .012), age at diagnosis (15.0; 13.7; 14.0 years; P = .003), family history of IBD (13%; 11%; 5%; P = .005), diagnostic delay (3.0; 3.0; 2.0 months; P = .001), and smoking prevalence (12%; 8%; 6%; P = .041) were different between the 3 groups. Bloody stools at diagnosis were observed in 15%, 44%, and 91% for, respectively, CD-L1, CD-L2, and UC (P < .001), and diarrhea in 47%, 72%, and 65% (P < .001). At diagnosis, the presence of granuloma was identified in 13% of CD-L1 patients and 31% of CD-L2 patients (P < .001). The risk of extension to L3 was significantly higher in the CD-L2 group than in the CD-L1 group (at 5 years-37% vs. 14%, P < .001). L2 location was associated with a lower risk of luminal fistula (hazard ratio [HR] 0.4 [0.2-0.6], P < .001) but was associated with a higher risk of anoperianal lesion (HR 2.1 [1.3-3.4], P = .003). The prevalence of extraintestinal manifestations, articular (P < .001) and cutaneous (P < .001), was higher in CD-L2. While the 5-year risk of surgery was significantly higher in case of CD-L1 (37%, 13%, and 13%; P < .001), the 5-year exposure to corticosteroids (55%, 69%, and 67%; P < .001), immunosuppressants (47%, 61%, and 42%; p < .001), and anti-TNF (16%, 35%, and 21%; P < .001) were higher in case of L2 location.

Conclusions: The clinical presentation and evolution of ileal and colonic CD differ significantly in children. Colonic location is associated with a high risk of perianal CD, extraintestinal manifestations, and exposure to steroids, immunosuppressants, and anti-TNFs. These differences could justify different therapeutic approaches.

Keywords: Crohn’s disease; colonic; ileum; natural history; ulcerative colitis.

Plain language summary

While Crohn’s disease (CD) does not seem to be a singular disease, we observed in this population-based study that the natural history of ileal and colonic CD differs significantly in children. Colonic location is associated with a high risk of perianal CD and extraintestinal manifestations justifying different therapeutic approaches.

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Abstract

Plain language summary

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