Isolated Crohn's Colitis: Is Localization Crucial? Characteristics of Pediatric Patients From the CEDATA–GPGE Registry

Elonen, Lotta; Wölfle, Lena Mareike; Laffolie, Jan de; Posovszky, Carsten

doi:10.3389/fped.2022.875938

Cited by 3 publications

(2 citation statements)

References 38 publications

(59 reference statements)

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“…Isolated colonic CD (L2) has been considered a distinct disease when compared to ileal or ileocolonic CD. 15,16 Ileal involvement was associated with an increased risk of change in disease behavior and developing an intestinal complication relative to colonic CD. 17 We found L2 subtype was a protective factor, which was consistent with the previous studies.…”

Section: Discussionmentioning

confidence: 97%

A nomogram incorporating ileal and anastomotic lesions separately to predict the long-term outcome of Crohn’s disease after ileocolonic resection

Xiong,

He,

Chen

et al. 2023

Therap Adv Gastroenterol

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Background: The Rutgeerts score (RS) is widely used to predict postoperative recurrence after ileocolonic resection for Crohn’s disease (CD) based on the severity of lesions at the neoterminal ileum and anastomosis (RS i0–i4). However, the value of anastomotic ulcers remains controversial. Objectives: Our aim was to establish a nomogram model incorporating ileal and anastomotic lesions separately to predict the long-term outcomes of CD after ileal or ileocolonic resection. Design: A total of 136 patients with CD were included in this retrospective cohort study. Methods: Consecutive CD patients who underwent ileal or ileocolonic resections with postoperative ileocolonoscopy evaluation within 1 year after the surgery were included. The primary endpoint was postoperative clinical relapse (CR). An endoscopic classification separating ileal and anastomotic lesions was applied (Ix for neoterminal ileum lesions; Ax for anastomotic lesions). A nomogram was constructed to predict CR. The performance of the model was evaluated by the receiver-operating characteristic (ROC) curve and decision curve analysis (DCA). Results: CR was observed in 47.1% ( n = 64) of patients within a median follow-up of 26.9 (interquartile range, 11.4–55.2) months. The risk of CR was significantly higher in patients with an RS ⩾ i2 assessed by the first postoperative endoscopy compared with patients with an RS ⩽ i1 ( p < 0.001). Moreover, the cumulative rate of CR was significantly higher in patients with ileal lesions (I1–4) compared with patients without (I0) ( p < 0.001). Besides, patients with anastomotic lesions (A1–3) had significantly higher rates of CR than patients without (A0) ( p = 0.002). A nomogram, incorporating scores of postoperative ileal or anastomotic lesions, sex, L2-subtype and perianal disease, was established. The DCA analysis indicated that the nomogram had a higher benefit for CR, especially at the timeframe of 24–60 months after index endoscopy, compared to the traditional RS score. Conclusion: A nomogram incorporating postoperative ileal and anastomotic lesions separately was developed to predict CR in CD patients, which may serve as a practical tool to identify high-risk patients who need timely postoperative intervention.

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Section: Discussionmentioning

confidence: 97%

A nomogram incorporating ileal and anastomotic lesions separately to predict the long-term outcome of Crohn’s disease after ileocolonic resection

Xiong,

He,

Chen

et al. 2023

Therap Adv Gastroenterol

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“…In registries, one can support this by applying new classification systems to previously documented cases with known follow-up and outcome. In PIBD, this is currently reflected by the definition of atypical UC but also the role of isolated Crohn’s colitis [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

How can patient registries facilitate guideline-based healthcare? A retrospective analysis of the CEDATA-GPGE registry for pediatric inflammatory bowel disease

Leiz¹,

Knorr²,

Moon³

et al. 2023

BMC Health Serv Res

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Background Early diagnosis is mandatory for the medical care of children and adolescents with pediatric-onset inflammatory bowel disease (PIBD). International guidelines (‘Porto criteria’) of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend medical diagnostic procedures in PIBD. Since 2004, German and Austrian pediatric gastroenterologists document diagnostic and treatment data in the patient registry CEDATA-GPGE on a voluntary basis. The aim of this retrospective study was to analyze whether the registry CEDATA-GPGE reflects the Porto criteria and to what extent diagnostic measures of PIBD according to the Porto criteria are documented. Methods Data of CEDATA-GPGE were analyzed for the period January 2014 to December 2018. Variables representing the Porto criteria for initial diagnostic were identified and categorized. The average of the number of measures documented in each category was calculated for the diagnoses CD, UC, and IBD-U. Differences between the diagnoses were tested by Chi-square test. Data on possible differences between data documented in the registry and diagnostic procedures that were actually performed were obtained via a sample survey. Results There were 547 patients included in the analysis. The median age of patients with incident CD (n = 289) was 13.6 years (IQR: 11.2–15.2), of patients with UC (n = 212) 13.1 years (IQR: 10.4–14.8) and of patients with IBD-U (n = 46) 12.2 years (IQR: 8.6–14.7). The variables identified in the registry fully reflect the recommendations by the Porto criteria. Only the disease activity indices PUCAI and PCDAI were not directly provided by participants but calculated from obtained data. The category ‘Case history’ were documented for the largest part (78.0%), the category ‘Imaging of the small bowel’ were documented least frequently (39.1%). In patients with CD, the categories ‘Imaging of the small bowel’ (χ2 = 20.7, Cramer-V = 0.2, p < 0.001) and ‘Puberty stage’ (χ2 = 9.8, Cramer-V = 0.1, p < 0.05) were documented more often than in patients with UC and IBD-U. Conclusion The registry fully reproduces the guideline’s recommendations for the initial diagnosis of PIBD. The proportion of documented diagnostic examinations varied within the diagnostic categories and between the diagnoses. Despite technological innovations, time and personnel capacities at participating centers and study center are necessary to ensure reliable data entry and to enable researchers to derive important insights into guideline-based care.

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Interdisziplinäre Vernetzung bei chronischen Erkrankungen – klinische Versorgung

Laffolie¹

2023

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Ein erheblicher Anteil der Kinder und Jugendlichen in Deutschland leidet unter chronischen Erkrankungen wie Asthma bronchiale, Diabetes mellitus, Adipositas oder Allergien, aber auch an vielzähligen selteneren, komplexen Erkrankungen. Diese Erkrankungen sind oft durch rasche Fortschritte in Diagnostik und Therapie sowie multimodale Behandlungskonzepte mit zum Teil sehr teuren neuen Medikamenten gekennzeichnet. Versorgungsdefizite sind häufig, zumal oft das nötige Spezialwissen und damit verbundene Erfahrung nicht überall in gleicher Weise zur Verfügung steht und ein hoher Kommunikationsaufwand besteht. Die Behandlung sollte interdisziplinär und intersektoral integriert mit Beteiligung der Patienten und Familien erfolgen, dies wird in der aktuellen marktwirtschaftlich orientierten Organisation des Gesundheitswesens jedoch nicht befördert. Die Maxime der Kostenreduktion gerade im stationären Sektor fällt hier besonders ins Gewicht. In diesem Beitrag sollen wesentliche Strukturen und Prozesse sowie Veränderungsperspektiven aufgezeigt werden.

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Isolated Crohn's Colitis: Is Localization Crucial? Characteristics of Pediatric Patients From the CEDATA–GPGE Registry

Cited by 3 publications

References 38 publications

A nomogram incorporating ileal and anastomotic lesions separately to predict the long-term outcome of Crohn’s disease after ileocolonic resection

A nomogram incorporating ileal and anastomotic lesions separately to predict the long-term outcome of Crohn’s disease after ileocolonic resection

How can patient registries facilitate guideline-based healthcare? A retrospective analysis of the CEDATA-GPGE registry for pediatric inflammatory bowel disease

Interdisziplinäre Vernetzung bei chronischen Erkrankungen – klinische Versorgung

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