Abstract
Objective: Pediatric Crohn’s disease (CD) is often debilitating, with upper gastrointestinal involvement and complications over time. Treatment with TNF blockers can induce and maintain remission. We wanted to evaluate the outcome of patients medically treated for CD to investigate whether clinical, endoscopic and biochemical factors at diagnosis are associated with the early initiation of treatment with the TNF blocker infliximab.
Materials and Methods: Patients aged <18 years, diagnosed with CD were characterized according to the Porto criteria, with endoscopy, MRI and biochemical tests before individual treatment. They were followed prospectively until a prescheduled examination within two years.
Results: Thirty-six pediatric patients were included, 18 (50%) received infliximab. Infliximab treated patients had shorter disease duration, more upper gastrointestinal involvement (p=0.03) and higher median CRP (28 versus 7.5 mg/l, p=0.02), ESR (32 versus 18 mm/h, p=0.01) and fecal calprotectin (1506 versus 501 mg/kg, p= 0.01) levels. Infliximab treatment was well tolerated, and 15 /18 of patients achieved clinical remission. At follow up 11/17 in the infliximab group and 8/13 in the non-infliximab group achieved ileocolonic mucosal healing. A majority in the infliximab group had a marked reduction of CD specific upper gastrointestinal lesions but persistence of unspecific upper GI inflammation at follow-up.
Conclusion: High levels of inflammatory markers and upper gastrointestinal lesions were associated with initiation of infliximab treatment. A substantial proportion of patients still had unspecific lesions in the upper GI regardless of treatment. Future studies must clarify the prognostic role of persistent upper gastrointestinal-involvement despite mucosal healing in the ileocolon.