Perianal pediatric Crohn disease is associated with a distinct phenotype and greater inflammatory burden

Abstract

Growth deceleration and impaired pubertal growth spurt are common concerns in patients with early onset inflammatory bowel disease (IBD) (1-2). Previous studies confirmed the efficacy and safety of infliximab, an anti-tumor necrosis factor alpha (TNF-α) antibody, in achieving clinical remission in luminal Crohn’s disease (CD) and in facilitating linear growth (3). The present study describes in depth the specific characteristics of children with perianal CD (pCD), a sub-category of CD patients that appears to exhibit a higher level of inflammation. Previous studies reported a higher rate of intestinal resection in patients with pCD. As the authors state, the lack of this association in the present cohort could be linked to the currently recommended prompt start of anti-TNFa agents in the presence of perianal disease, that alters the natural history of the disease. This study reports reduced height Z-scores in children with pCD. It should be noted that height data were not correlated to the target height. Similarly, no data about growth velocity, pubertal stage and/or bone age of patients were available. For these reasons, it appears interesting to investigate in more detail the growth aspects in this sub-category of patients with IBD.