Natural history of children with mild Crohn’s disease

Table 1 Characteristics of mild Crohn’s patients at diagnosis, n (%)

Variables	Mild case (n = 29)	Moderate or severe case (n = 58)	P value
Age at diagnosis, yr	10.0 (4.2)	11.6 (3.3)	0.06
Male %	15 (51.7)	29 (52.7)	0.93
Paris Location at diagnosis
Lower 1/3 of ileum +/- base of cecum	6 (20.7)	7 (12.1)	0.29
Colon only	9 (31.0)	7 (12.1)	0.03
Ileum and colon	13 (44.8)	41 (70.7)	0.02
Upper GI proximal to ligament of treitz	7 (24.1)	25 (43.1)	0.08
Distal to ligament of treitz to proximal ileum	1 (3.5)	2 (3.5)	1.00
Disease behavior at diagnosis
Inflammatory (non-stricturing, non-penetrating)	28 (96.6)	51 (87.9)	0.19
Stricturing	0 (0)	3 (5.2)	0.21
Penetrating	0 (0)	1 (1.7)	0.48
Perianal	3 (10.3)	12 (20.7)	0.23

GI: Gastrointestinal.

Table 2 Outcome of mild disease patients after the first 2 years of study entry

	n (%)
Starting immunomodulator	8 (27.6)
Starting biologic	0
Starting immunomodulator and biologic	0
Surgery	0
Continued on minimal therapy	21 (72.4)

Table 3 Predictors of escalation to immunomodulators among mild Crohn’s patients

	Univariate	P value
	Hazard ratio (95%CI)
Age at diagnosis	1.24 (0.97-1.59)	0.09
Gender (female vs male)	0.67 (0.15-3.00)	0.60
Paris location at diagnosis
Lower 1/3 of ileum +/- base of cecum	1.29 (0.30-5.66)	0.73
Colon only	0.96 (0.19-4.99)	0.96
Ileum and colon	0.50 (0.10-2.53)	0.40
Upper GI proximal to Ligament of Treitz	1.00 (0.19-5.17)	1.00
Distal to Ligament of Treitz to proximal ileum	5.46 (0.61-49.27)	0.13
Any steroids in the first 2 yr	1.26 (0.30-5.35)	0.75
Any steroids after the first 2 yr	12.1 (1.4-102.7)	0.02
Complications	5.6 (1.3-24.9)	0.02

GI: Gastrointestinal.

Table 4 Detailed outcomes of 29 patients on no immunosuppressive therapy for mild Crohn’s disease

Year (age) of diagnosis	Duration of follow-up after initial 2 yr of treatment (mo)	Followup colonoscopy histology findings	Medications	Outcome/ complications
2002 (10 yr)	111	2007-normal colonoscopy	5-ASA (Asacol), prednisone	Escalation to 6MP(age 20) Surgery for ileal stricture (age 22)
2004 (12 yr)	49	2009-Noncaseating granulomas in TI and throughout colon.	5-ASA (Pentasa, Lialda)	Stayed on ASA, no escalation
2001 (9 yr)	32	Not done	5-ASA, prednisone	Stayed on ASA, no prednisone after induction, no escalation
2002 (10 yr)	131	2009- chronic active ileitis with ulceration	5-ASA (Pentasa, Lialda)	2015-escalation to mercaptopurine, then adalimumab
2003 (10 yr)	66	2010-severely active ileitis	5-ASA (Pentasa), 3 courses of prednisone over 3 years	2012-began mercaptopurine
2005 (13 yr)	15	Not done	5-ASA (Asacol)	Ileal phlegmon, treated with antibiotics and subsequent mercaptopurine
2010 (16 yr)	43	2014-nonnecrotizing granuloma throughout the colon	5-ASA (Asacol)	Stayed on ASA, no escalation.
2010 (16 yr)	1	Not done	5-ASA (Asacol), hydrocortisone	Stayed on ASA, no steroid after initial induction
2008 (14 yr)	63	2010-mild active ileitis colitis in ascending and sigmoid colon	5-ASA (Asacol), metronidazole	Stayed on ASA, no escalation
2012 (17 yr)	7	2014-nonnecrotizing granulomas in left colon	5-ASA (Pentasa)	Escalation to mercaptopurine, then adalimumab
2008 (14 yr)	65	2012-normal ileum, chronic active colitis 2016-normal colonoscopy	5-ASA (Pentasa), budesonide	No escalation
2008 (13 yr)	47	2014-mild active colitis, in ascending, granuloma in ileum	5-ASA (Pentasa), metronidazole	6MP initiated
2007 (12 yr)	71	2016-Inactive colitis at IC valve	5-ASA (Asacol)	Ileal stricture in 2016, no surgery yet
2008 (13 yr)	21	2009-active colitis in cecum, inactive in remainder of colon	5-ASA (Pentasa, Lialda)	Discontinued all therapy, never hospitalized
2005 (10 yr)	14	None prior to escalation	5-ASA (Pentasa), metronidazole	6MP, then infliximab
2010 (15 yr)	6	None	5-ASA (Pentasa), prednisone induction	No escalation
2005 (9 yr)	85	2013-focal mild ileitis	5-ASA (Pentasa), metronidazole	No escalation
2000 (4 yr)	1	Not done	Sulfasalazine, flagyl	Begun infliximab for colonic and perianal disease
2002 (12 yr)	38	2012-normal colonoscopy	5-ASA (mesalamine), prednisone	No escalation
2006 (9 yr)	87	2016-chronic active colitis, non- necrotizing granuloma in transverse colon	5-ASA (Pentasa), two courses of steroids in first two years	No escalation
2002 (4 yr)	136	2010-mild active colitis	Sulfasalazine, budesonide	No escalation
2001 (3 yr)	100	Not done	Sulfasalazine, budesonide	No escalation
2003 (5 yr)	118	2012-focal moderately active colitis	Sulfasalazine, prednisone	No escalation
2009 (10 yr)	41	2014-focal acute inflammation	5ASA (Asacol), Budesonide	No escalation
2005 (7 yr)	99	2014-mildly active colitis	Pentasa	No escalation
2007 (6 yr)	97	2013- chronic inactive colitis	Pentasa, Sulfasalazine	No escalation
2012 (10 yr)	16	2013-mild active colitis with granulomata	Asacol, prednisone induction	No escalation
2008 (3 yr)	54	Not done	Sulfasalazine, probiotics	No escalation
2010 (3 yr)	11	2012-chronic moderately active colitis	Sulfasalazine, prednisone induction	No escalation