Features of the course of Crohn's disease depending on patient’s age at disease onset

Abstract

В данной работе освещается проблема особенностей течения болезни Крона у пациентов разных возрастных групп, в частности, в детском возрасте. Актуальность данной проблемы не вызывает сомнений, вследствие роста числа новых случаев болезни Крона в последние десятилетия и снижения среднего возраста пациентов. Диагностика и лечение болезни Крона в детском возрасте имеют свои особенности и не могут быть основаны на экстраполяции подходов к диагностике и лечению болезни у взрослых. В данной работе отражены современные взгляды на этиологию и патогенез болезни Крона, а также возрастные особенности болезни. Работа содержит анализ современных подходов к диагностике и лечению болезни Крона в разных возрастных группах по данным российской и мировой литературы. В ходе исследования были проанализированы две возрастные группы пациентов. Первая группа составила 42 человека, возраст начала заболевания которых составил от 10 до 16 лет, что соответствует A1b категории Монреальской классификации. Вторая группа включала 44 человека, у которых первые симптомы болезни Крона возникли после 40 лет, что соответствует A3 категории Монреальской классификации. Все пациенты имели воспалительный фенотип болезни Крона на момент установления диагноза. Статистический анализ был выполнен с использованием GraphPad Prism 6 (Graph Pad Software, США). Различия считались статистически значимыми при уровне «p» менее 0,05.

BACKGROUND: The incidence of Crohn's disease is increasing in developed countries. 20-30% of all patients with Crohn's disease take a person under the age of 20 years. In the children's age group, the course of the disease has not been studied enough. The aims of the study were to compare lesion localizations, clinical manifestations and laboratory parameters in children and adults groups and to determine factors influencing unfavorable course of the disease depending on the age of onset. MATERIALS AND METHODS: This study includes two age groups. First group includes 42 person according to A1b of the Paris classification ( 10 - 16 years). Second group includes 44 person according to A3 of the Paris classification ( > 40 years). Both groups had an inflammatory disease phenotype. Exclusion criteria were stricture and penetrating forms of the disease. Statistical analysis was made using GraphPad Prism 6 (Graph Pad Software, USA). Differences were considered statistically significant at a «p» level less than 0.05. RESULTS: In the age group 10–16 years lesions of the ileum and colon prevailed (57.1%). In the age group older than 40 colon lesions prevailed (55.4%). Children often had combination of the upper and lower sections (52%), which is one of the factors of severe course of the disease; among adults lesions of the upper sections was not observed (0%). Extensive lesions (more than 2 localizations) were significantly more common in pediatric age group (51.2% / 4.3%). The most frequent symptoms in children were fever, abdominal pain and articular syndrome. In adults, the disease is most often manifested by diarrhea, impurities in the stool and weight loss. Extraintestinal clinical manifestations are significantly more common in children (42.9% / 17.4%). Complications developed significantly more often in children than among adults (57% / 41%) and there were severe. Because pediatric Crohn's disease was complicated by the development of strictures, stenoses that often require bowel resection and colostomy. The average time of diagnosis was 11.9 months in the age group 10–16 years and 25.1 months in the age group over 40 years old (p = 0.021). The level of fecal calprotectin negatively correlates with the age of onset. There is no statistically significant difference between the ESR and C-RB in adults and children. Children significantly more often require biological therapy ( anti – TNF drugs) to achieve remission than adults (52.3% / 4.5%). CONCLUTIONS: The results indicate more aggressive course of Crohn's disease in children which is manifested in a high frequency of complications and the impossibility of achieving remission without adding anti - TNF drugs to standard therapy. Due to a large number of factors of unfavorable prognosis of the disease in children (lesion of the upper sections, perianal lesions, high prevalence of lesions), it is necessary to actively diagnose Crohn's disease in children and establish the diagnosis as soon as possible. After that children require active and dynamic observation (with a certain frequency, with a detailed examination).