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Pediatric Crohn's disease from onset to adulthood: granulomas are associated with an early need for immunomodulation.
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2014 (English)In: Scandinavian journal of gastroenterology, ISSN 1502-7708, Vol. 49, no 8, 950-7 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Childhood onset Crohn's disease (CD) is considered more aggressive than adult onset disease. Epithelioid cell granulomas in intestinal biopsies are one, non-obligate, criterion of CD. We investigated granulomas as markers of CD severity in children followed to adulthood.

MATERIAL AND METHODS: Forty-five individuals with childhood onset CD were studied from diagnosis until attainment of final height, with data on disease location, medical and surgical management and with detailed growth data analyses. A blinded review of diagnostic biopsies was also performed.

RESULTS: We found granulomas in 22/45 (49%) children at diagnosis, altogether in 28/45 (62%) patients during the disease course (median overall follow-up - 12.3 years, range 9.3-18). Granulomas were found in 9/11 (82%) with upper gastrointestinal involvement (cumulatively 17/20, 85%) (p = 0.017 and p = 0.006, respectively). The time from diagnosis to initiating immune modulating treatment (median 4.5 months, range 0-75) was shorter in the granuloma-positive group (16/22) compared to the granuloma-negative group (18/23) (median 33 months, range 2-105; p = 0.01). The median standard deviation score height at diagnosis and final adult height (both adjusted for target height) did not correlate to findings of granulomas.

CONCLUSIONS: Epithelioid cell granulomas were associated with a shorter time to initiating immune modulating drugs, as a possible sign of more severe disease, but growth was not affected.

Place, publisher, year, edition, pages
2014. Vol. 49, no 8, 950-7 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-246314DOI: 10.3109/00365521.2014.920911PubMedID: 24866747OAI: oai:DiVA.org:uu-246314DiVA: diva2:792846
Available from: 2015-03-05 Created: 2015-03-05 Last updated: 2015-03-05

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