Medicine of the Future in America

Long-term prognosis of early-onset Crohn’s disease: DISCUSSION (Part 2)

Epithelial dysplasia in Crohn’s disease has been recorded elsewhere in the small and large intestine, leading others to hypothesize that the so-called ‘dysplasia-carcinoma sequence’ may occur in Crohn’s disease. Although very logical, data to support an endoscopic surveillance approach are limited in Crohn’s disease, and are largely based on a single study conducted in an older adult population. Indeed, most cases of carcinoma in adults with Crohn’s disease, even from large tertiary care settings, were detected only incidentally during surgical treatment. Evidence providing support for routine endoscopic surveillance in pediatric Crohn’s disease is lacking and should not be recommended based on the limited data from adult populations.

The present study also evaluated the role of clinical characteristics, based on a modified Vienna schema for early-onset or pediatric Crohn’s disease , and the likelihood for later intestinal resection(s). In this evaluation, the majority of males and females (56.3%) required at least one intestinal resection during the prolonged period of follow-up into adulthood. This exceeds the recorded frequency of 44.1% in a larger database , now with over 800 having adult-onset disease. These results are consistent with a prior report of a higher frequency of surgical treatment in early- versus late-onset disease over 40 years of age and also provide predictive data for anticipated intestinal resection after diagnosis of Crohn’s disease.

This entry was posted in Crohn’s disease and tagged Clinical behaviour of Crohn’s disease, Crohn's disease, Granulomatous colitis, Natural history of Crohn’s disease, Vienna classification.
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