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            <idno type="halRefHtml">&lt;i&gt;Inflammatory Bowel Diseases&lt;/i&gt;, 2010, 16 (6), pp.953-61. &lt;a target="_blank" href="https://dx.doi.org/10.1002/ibd.21152"&gt;&amp;#x27E8;10.1002/ibd.21152&amp;#x27E9;&lt;/a&gt;</idno>
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                <title xml:lang="en">Natural history of Crohn's disease: comparison between childhood- and adult-onset disease.</title>
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                    <forename type="first">Sheila</forename>
                    <surname>Viola</surname>
                  </persName>
                  <idno type="halauthorid">561060-0</idno>
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                <author role="aut">
                  <persName>
                    <forename type="first">Jérôme</forename>
                    <surname>Viala</surname>
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                  <idno type="halauthorid">158445-0</idno>
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                <author role="aut">
                  <persName>
                    <forename type="first">Laurent</forename>
                    <surname>Beaugerie</surname>
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                  <idno type="halauthorid">317806-0</idno>
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                  <affiliation ref="#struct-454982"/>
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                    <forename type="first">Jean-Philippe</forename>
                    <surname>Girardet</surname>
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                  <idno type="halauthorid">230389-0</idno>
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                    <surname>Ruemmele</surname>
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                    <surname>Cosnes</surname>
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                <idno type="eissn">1536-4844</idno>
                <title level="j">Inflammatory Bowel Diseases</title>
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                  <publisher>Lippincott, Williams &amp; Wilkins</publisher>
                  <biblScope unit="volume">16</biblScope>
                  <biblScope unit="issue">6</biblScope>
                  <biblScope unit="pp">953-61</biblScope>
                  <date type="datePub">2010-06</date>
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              <p>BACKGROUND: Childhood-onset Crohn's disease (CD) might reflect a more severe form of disease. To test this hypothesis we analyzed the long-term natural history of CD in an adult cohort of patients with childhood-onset compared to adult-onset CD. METHODS: We selected 206 childhood-onset CD patients among 2992 adult patients with a diagnosis of CD established before December 31, 2000. Disease characteristics were prospectively assessed during follow-up until December 2007 and compared to adult-onset CD patients matched 2 to 1 on gender, year of CD diagnosis, and disease location. RESULTS: Compared to adult-onset CD, patients with childhood-onset CD were more likely to have a severe disease, with an increased year-by-year disease activity index (37% of patient-years in childhood-onset group versus 31% in the adult-onset group, P &lt; 0.001). Immunosuppressant requirement was also increased with a 10-year cumulative risk of 54 +/- 3% in childhood-onset CD group versus 45 +/- 2%, in the adult-onset CD group (P &lt; 0.001). Cumulative risks of stricturing and penetrating complications and surgical resections were not statistically different between groups. Accordingly, these events occurred at a younger age in the childhood-onset CD group. At the age of 30 years the actuarial risk of having undergone an extensive intestinal resection was 48 +/- 5% in the childhood-onset group versus 14 +/- 2% in the adult-onset group (P &lt; 0.001). CONCLUSIONS: Patients with childhood-onset CD exhibit a more active disease and require more immunosuppressive therapy. This feature is observed irrespective of the disease location, suggesting an intrinsic more severe phenotype.</p>
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