Clinical Features And Related Factors Of Pediatric Crohn's Disease With Perianal Disease

Background: Crohn's disease(CD),a subtype of Inflammatory bowel disease(IBD),is a chronic recurrent disease of the whole gastrointestinal tract with diverse clinical symptoms and multisystem involvement.At present,the incidence of CD has increased significantly in global regions,including China.Perianal disease(PD),as one of the serious complications of CD in pediatric,causes great damage to the growth,mental health and quality of life.Objective: To evaluate the phenotypic characteristics and long-term disease-specific results of crohn's disease with perianal disease in children.And explore the influencing factors of perianal crohn's disease.Methods: The clinical data of forty-four children diagnosed with crohn's disease and met the inclusion criteria in Hunan Children's Hospital from January 2011 to January 2019 were retrospectively analyzed.The enrolled patients were divided into the perianal disease group and the non-perianal disease group according to the American gastroenterological association technical review criteria(2003 edition).Records included age,gender,height,weight,the time of initial diagnosis,the hospitalization days,primary clinical manifestation,contents of PD,other complications,Montreal classification,laboratory data,imaging examination,endoscopy,PCDAI,pathology results and treatment data,separately carries on the statistical analysis between groups,investigating the clinical features of crohn's disease with PD,and exploring related factors.Results:(1)There were 59.09%(n=26)of crohn's disease with perianal disease,with sex ratio of 5.5:1,mean age of diagnosis was(9.47±4.37 years).There was a statistical difference in gender composition and the mean age of first diagnosis between the groups(P<0.05),but the difference in the first hospitalization days was not statistically significant(P>0.05).(2)Among children with PD,the most common types are anal fistula and perianal abscess,accounting for 42.31% respectively,46.15%of the children had PD at the first diagnosis.After a median follow-up duration was 25.5 months(IQR: 18~43 months),the incidence of perianal lesions increased from 27.27% to 59.1%.The most common lesion site was ileocolon(69.23%),the upper digestive tract was involved 80.77%,and half of the children were penetrative.The lesion sites between groups has slight difference(P>0.05,no statistical significance).The difference in disease behavior was statistically significant(P=0.045).(3)The primary clinical manifestations of perianal involvement were mostly gastrointestinal symptoms,with abdominal pain accounting for 76.92%,periumbilical pain for 23.08%.Secondly,the systemic symptoms were mainly fever and weight loss,but the extraintestinal manifestations were less.The incidence of alimentary tract hemorrhage,intestinal stenosis,intestinal obstruction,intestinal perforation,short stature,severe malnutrition and severe electrolyte disturbance were3.85%,26.92%,3.85%,11.54%,7.69%,46.15% and 23.08% respectively.There are no significant differences in the comparison of the initial symptoms and serious complications between the groups(P>0.05).(4)The level of albumin in the PD group was significantly lower than that in the non-PD group,and the difference between the groups was statistically significant(P<0.01),whlie other serological indexes was not statistically significant(P>0.05).The differences in height,weight and Z score between the two groups were statistically significant(P<0.05).(5)In children with PD,colonoscopy and enteroscope showed the most common changes of aphthous ulcer,and the positive rate of upper digestive tract was 38.46%,among which 3.85% had typical cobblestone signs.The incidence of epithelioid nodule,recess change,granulation tissue hyperplasia,granuloma formation,and fissure like structure change in mucosal biopsy were 34.62%,23.08%,7.69%,7.69% and 15.38%.The children without PD had no granulation tissue proliferationor and fissurelike structure change.Almost all of the children in the perianal disease group had intestinal wall thickening with multislice CT enterography(95.24%)and abdominal intestinal ultrasound(96.15%).(6)Before treatment,PCDAI score of PD group was significantly higher than non-PD group,and the difference was statistically significant(p=0.0003).Comparison before and after treatment,the scores of PD group decreased more significantly,and the difference was statistically significant(p=0.0008).There was no statistically significant difference in the clinical remission rate between groups(P>0.05).In PD group,PCDAI score of hormone group was significantly lower than that of IFX group,and the difference was statistically significant(p<0.0001).Comparison before and after treatment,the scores of the IFX group in PD children decreased more significantly than those in the hormone group,and the difference was statistically significant(p=0.0001).There was no statistically significant difference in the clinical remission rate between the two groups(p > 0.05).(7)Male(OR=0.076,95%CI:0.008~0.755,p=0.028),young age at first diagnosis(OR=1.992,95%CI:1.011~3.926,p=0.047)and penetrating phenotype(OR=0.072,95%CI:0.005~0.989,p=0.049)were risk factors for perianal involvement.Conclusion:(1)Male,early age of first diagnosis and penetrative phenotype are independent risk factors for various types ofperianal lesions.When young children,especially boys,have perforation,fistula and other deep penetrating lesions,crohn's disease screening may be considered.(2)Children's low PD nutrient levels significantly,which is worthy of nutritional support.(3)The disease activity index of PD crohn's disease in children showed moderate-severe inflammatory changes.The use of IFX alone or hormone therapy alone can effectively control the inflammatory response of the disease,and the activity level of IFX can control the disease with better efficacy.The clinical remission rate after IFX treatment is higher than that after hormone therapy.