Long-Term Follow-Up of Pediatric Patients with Crohn’s Disease Involving Proximal Small Bowel

1.1.Background: Approximately 25% of inflammatory bowel diseases are diagnosed in childhood, which may have unfavorable repercussions over time, associated with the possibility of a worse prognosis when the proximal small bowel is involved.Thus, a better understanding of the course of this pathology in the pediatric population is necessary.The aim of this study is to describe the clinical and endoscopic activity of pediatric patients with Crohn's disease with involvement of the proximal small intestine in two periods, with an interval of 10 years between them. Methods:A prospective cohort study was performed in pediatric patients with Crohn's disease and involvement of the proximal small bowel confirmed by double-balloon enteroscopy.These patients were evaluated clinically and endoscopically, both at the time of enteroscopy and after 10 years of follow-up. Results: 20 pediatric patients diagnosed with Crohn's disease and proximal small bowel involvement were evaluated.The mean age was 11 years with the majority being male.There was a statistically significant improvement in the global indices of inflammatory and endoscopic activity after 10 years of follow-up, however, when analyzing patients with early or very early onset of the disease, clinical and especially endoscopic remission were not achieved in most of these patients, being that 4 progressed to surgery. Conclusion:There was clinical and endoscopic improvement of patients over 10 years, nonetheless, in patients diagnosed before 10 years old, there was worse evolution and difficulty in achieving deep remission despite biological therapy, suggesting a distinct phenotype, with more aggressive disease.