Pediatr Gastroenterol Hepatol Nutr.  2020 Jan;23(1):49-62. 10.5223/pghn.2020.23.1.49.

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts

Affiliations
  • 1Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea. bhchoe@knu.ac.kr
  • 2Crohn's and Colitis Association in Daegu-Gyeongbuk (CCAiD), Daegu, Korea.
  • 3Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 4Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
  • 7Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
  • 8Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
  • 9Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 10Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 11Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.
  • 12Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 13Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 14Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea.

Abstract

PURPOSE
We aimed to investigate the disease phenotype of Korean pediatric Crohn's disease (CD) patients at diagnosis according to the Paris classification by comparison with patients from the European multicenter 5-years recruitment of children with newly developed IBD (EUROKIDS registry).
METHODS
Korean children and adolescents who had been newly diagnosed with CD at the age of < 18 years during 2013-2016 were included in this multicenter retrospective study. Disease phenotype at diagnosis was classified according to the Paris classification, and compared with the published data from the EUROKIDS study.
RESULTS
A total of 255 patients were included. The median diagnosis age was 14.7 years (range, 0.8-17.9 years). No significant difference was observed in male-to-female ratio with EUROKIDS (1.9:1 vs. 1.45:1, p=0.062). The proportion of children aged < 10 years was significantly lower in Koreans (7.1% vs. 19.6%, p < 0.001). Colonic disease was less prominent (10.0% vs. 27.3%, p < 0.001), while upper GI involvement was more prominent in Korean children (59.3% vs. 46.2%, p < 0.001). The proportion with perianal fistulizing disease at diagnosis was significantly higher in Korean patients (44.8% vs. 8.2%, p < 0.001). A separate analysis of Korean patients revealed that perianal fistulizing disease at diagnosis was positively associated with male sex and body mass index z-score (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.20-3.76, p=0.010; and OR=1.29, 95% CI=1.05-1.58, p=0.015, respectively).
CONCLUSION
Approximately half of pediatric CD patients in Korea present with perianal fistulas and/or abscesses at diagnosis, which is a distinct feature of CD in Korean children and adolescents compared to their European counterparts. An underlying genetic difference between ethnicities may play a role in this expression of different phenotypes in pediatric CD.

Keyword

Crohn disease; Fistula; Abscess; Paris; Classification; Phenotype; Korea; Europe; Pediatrics; Inflammatory bowel disease
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