Perianal Pediatric Crohn Disease Is Associated with a Distinct Phenotype and Greater Inflammatory Burden

Amit Assa*, Michal Amitai, Mary Louise Greer, Denise A. Castro, Ruth C. Kuint, Maria Martínez-León, Izabela Herman-Sucharska, Eva Coppenrath, Sudha Anupindi, Alexander Towbin, Douglas Moote, Osnat Konen, Li Tal Pratt, Anne Griffiths, Dan Turner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objectives: Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults. Methods: Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months. Results: Of the 234 included patients (mean age 14.2 ± 2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ± 0.7 vs 4.5 ± 0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings. Conclusions: Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.

Original languageAmerican English
Pages (from-to)293-298
Number of pages6
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number3
StatePublished - 1 Sep 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


  • children
  • fistula
  • growth
  • penetrating
  • stricturing


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