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

• Kang B
• Kim JE
• Jung JH
• Choe JY
• Kim MJ
• Choe YH
• Kim S
• Koh H
• Lee YM
• Lee JH
• Lee Y
• Lee JH
• Lee HJ
• Jang HJ
• Choi Y
• Choi SY
• Kim JY
• Choe BH

• KMID: 2467893
• DOI: http://doi.org/10.5223/pghn.2020.23.1.49

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

MeSH Terms

Abscess
Adolescent*
Body Mass Index
Child*
Classification
Colonic Diseases
Crohn Disease*
Diagnosis*
Europe
Fistula
Humans
Inflammatory Bowel Diseases
Korea
Male
Pediatrics
Phenotype
Retrospective Studies

Figure

• 

  Fig. 1 Flow diagram of the study. CD: Crohn's disease, GI: gastrointestinal.

• 

  Fig. 2 Proportion of disease involvement across the entire gastrointestinal tract and perianal region.

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