In paediatric patients, Crohn's disease often presents with an inflammatory phenotype. However, a subgroup of individuals develop complicated disease behaviours (stricturing or fistulizing) over time so a model for predicting the risk of complications is needed to guide treatment decisions. In the latest study, Kugathasan et al. performed a multicentre, prospective, inception cohort study in children (n = 913) newly diagnosed with Crohn's disease and free of initial complications. After 36 months of follow-up, 9% of patients developed disease complications and a validated risk-prediction model based on clinical, serological, microbial and gene expression factors was found to have a sensitivity of 66%, a specificity of 71% and a negative predictive value of 94%. Also, patients who received early anti-TNF therapy were less likely to have fistulizing complications but not stricturing complications. Thus, this model could identify patients at low-risk of complications and prioritize those that might benefit from anti-TNF therapy.
Kugathasan, S. et al. Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study. Lancet http://dx.doi.org/10.1016/S0140-6736(17)30317-3 (2017)
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Dickson, I. Risk stratification in children with Crohn's disease. Nat Rev Gastroenterol Hepatol 14, 260 (2017). https://doi.org/10.1038/nrgastro.2017.48