De Novo Crohn's Disease in Children With Ulcerative Colitis Undergoing Ileal Pouch-Anal Anastomosis: A Multicenter, Retrospective Study From the Pediatric IBD Porto Group of the ESPGHAN

M Martinelli, E Romeo, T Caldaro, K Dimakou, A Papadopoulou, M Matar, A Assa, V Dipasquale, C Romano, M Aloi, P Alvisi, D Röser, KL Kolho, N Afzal, O Ledder, S Cohen, J Bronsky, JC Escher, A Brueckner, R ShamirA Staiano*, E Miele

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

Background and Aims:

We sought to define the prevalence and to characterize possible predictive factors of Crohn’s disease (CD) occurring in children with ulcerative colitis (UC) after ileal pouch–anal anastomosis (IPAA).

Methods:

This was a multicenter, retrospective study including 15 centers of the Porto IBD group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Children with a confirmed diagnosis of UC undergoing colectomy with IPAA and a minimal follow up of 6 months were identified. The following data were collected: demographic data; endoscopic and histologic data; disease activity; laboratory exams; therapeutic history; indication for surgery, type, and timing; and IPAA functional outcomes and complications. In de novo CD cases, time of diagnosis, phenotype, location, and therapies were gathered.

Results:

We identified 111 UC children undergoing IPAA from January 2008 to June 2018 (median age at colectomy: 13 years; age range: 1-18 years; female/male: 59/52). The median time from diagnosis to colectomy was 16 (range, 0-202) months. At the last follow-up, 40 (36%) of 111 children developed pouchitis. The criteria for de novo CD were met in 19(17.1%) of 111 children with a 25-month median (range, 3-61 months). At last follow-up, 12 (63.1%) of 19 were treated with biologics and in 5 (26.3%) of 19 children, the pouch was replaced with definitive ileostomy. In a multivariable logistic regression model, decreased preoperative body mass index z scores (odds ratio, 2.2; 95% confidence interval, 1.1-4.4; P = .01) resulted as the only variable associated with CD development.

Conclusions:

Children with UC undergoing IPAA carry a high risk of developing subsequent CD. De novo CD cases showed decreased preoperative body mass index z scores, identifying a poor nutritional status as a possible predictive factor.
Original languageEnglish
Article numberizad199
Number of pages7
JournalInflammatory Bowel Diseases
DOIs
Publication statusE-pub ahead of print - 10 Oct 2023

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