Upper gastrointestinal involvement in paediatric onset Crohn's disease: Prevalence and clinical implications

Background and aims: Our study evaluated the prevalence, the characteristics and implications of the upper gastrointestinal localisation (UGI+) in paediatric Crohn's Disease (CD) patients. Methods: This prospective study evaluated 45 newly diagnosed CD patients at diagnosis and follow up with respect to CD localisation. Results: All patients presented CD at the colon and/or ileum. In 24/45 patients (53.3%, 12 F and 12 M) an UGI+ involvement was also found. UGI+ patients had a younger age of onset (10.9 years versus 12.6 years; P < 0.05). PCDAI at diagnosis was significantly higher in the UGI+ (41 vs. 25 P < 0.01). UGI+ patients were overall more symptomatic. Pancolitis and extraintestinal manifestations were also more frequent (19/24 (80%) vs. 12/21 (57%) P < 0.01). Growth was more impaired at diagnosis in UGI+ patients. By the end of the follow-up (mean 3 years, range 2 to 4) no significant difference was found in PCDAI (17 in UGI+ patients vs. 11 in UGI− P = NS), or the number of relapses. Weight and growth catch-up in UGI+ patients were comparable to UGI− ones. However, UGI+ patients required a more aggressive therapeutic approach. Conclusion: At least half of paediatric onset CD patients have an upper gastrointestinal localisation. UGI+ patients present an earlier onset and a more severe disease. The final outcome does not differ, but UGI+ patients require a more aggressive therapeutic approach. Highlights: ► We evaluated the upper gastrointestinal localization in paediatric Crohn’s Disease (CD)patients. ► At least half of paediatric onset CD patients have an upper gastrointestinal localization. ► Patients with upper involvement present an earlier onset and a more severe disease. ► The final outcome does not differ, but patients with upper involvement require more aggressive therapy.