Pediatric Penetrating Crohn's Disease
Pediatric Penetrating Crohn's Disease
The incidence of Crohn's disease (CD) increased the last few years, especially in children,
 with 20% percent of CD patients diagnosed during childhood. The CD is a chronic disease
 without curative treatment, medical or surgical, and evolution is longer in children, avoid
 iterative digestive resections and their consequences in these patients is a major issue.

 The beginning of the disease at pediatric age is considered to be a poor prognostic factor
 and is considered to be more aggressive than that of adults: more extensive, more active and
 requiring more immunosuppressive treatments, with a more frequent dependence on
 corticosteroids and a shorter delay between the beginning of symptoms and the first surgery.
 After 5 years of evolution, 13 to 50% of patients with early pediatric MC have undergone
 intestinal resection.

 The Paris' classification defined 3 phenotypes or behaviors in pediatric Crohn's disease.
 Penetrating phenotype (B3) is a heterogeneous group defined by the presence of
 intra-abdominal perforation, fistulas or abscesses. The B3 phenotype is a risk factor for
 pejorative evolution in CD with a risk increased of surgical resection.

 In the pediatric population, the natural history of patients with penetrating CD is unknown.
 Most studies focus on CD beginning at pediatric age but with penetrating complications
 occurring in adulthood or pediatric penetrating CD but with relatively short follow-up. The
 risk of recurrence of the penetrating disease after a first complication in childhood is
 unknown, the factors influencing this risk also. And, there is no consensus either concerning
 optimal B3 management in children, and the practices are variable from specialist to
 specialist.

 After describing the pediatric population with penetrating CD, the aim of this study was to
 know the incidence of bowel resection for B3 episode. The secondary aims were to describe the
 immediate management and long-term evolution of these patients and to identify risk factors
 for adverse evolution.
This study is cross-sectional and is carrying out between 1995 and 2017 in two French
 tertiary referral centers (Montpellier, Toulouse) and EPIMAD registry which is currently the
 largest Inflammatory Bowel Disease cohort in world and cover 9.6% of French population (Nord,
 Pas-de-Calais, Somme, and Seine-Maritime department).

 All patients diagnosed with CD who had underwent a B3 complication (intra-abdominal abscess,
 fistula, perforation, peritonitis, or phlegmon) before the age of 18. Patient having isolated
 perineal disease, indeterminate colitis or with too much missing data were excluded.

 The main endpoint: incidence of intestinal resection performed for B3 complication.

 The secondary endpoints:

 -  description of the pediatric population with B3 complication with:

 -  demographic data: sex, family history, phenotype of the disease according to the Paris
 classification, age at diagnosis of B3, period of diagnosis of B3 (before or after
 2001), time between the diagnosis of CD and the diagnosis of B3, a history of medical
 and surgical treatment for CD received before B3.

 -  clinical data: type of B3 complication, presence of stenosis and its location, clinical
 symptoms (fever, obstructive symptoms), nutritional status.

 -  description of the immediate management of these patients, specifying: the place of
 care, the type of immediate management performed, the drug treatments received in the
 acute phase, the medical treatments for CD introduced for the B3 episode, the intestinal
 resections performed for the B3 episode, the realization of a stoma, the radiological
 drainage of abscesses, the immediate complications of B3.

 -  description of the long-term evolution of these patients, specifying: the given drug
 treatments, the clinical recurrence of the CD, the recurrence of B3, the need for
 intestinal resection during follow-up, the occurrence of other events

 -  identification of risk factors for pejorative evolution defined by "recurrence of B3" or
 "intestinal resection" in these patients.
Inclusion criteria:

 - patients diagnosed with CD who had underwent a B3 complication (intra-abdominal abscess,
 fistula, perforation, peritonitis, or phlegmon)

 Exclusion criteria:

 -  patient having isolated perineal disease, indeterminate colitis or with too much
 missing data were excluded

 -  patients refuse the use of medical data will be excluded.