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A European Survey on Digestive Perianastomotic Ulcerations, a Rare Crohn-like Disorder Occurring in Children and Young Adults

Chrystele Madre 1 Mario Mašić 2 Daniela Prlenda-Touilleux 3 Annecarin Brueckner 4 Sibylle Koletzko 4 Alexandre Fabre 5, 6 Jérome Viala 7 Rosa Lima 8 Raphael Enaud 9 Julie Lemale 10 Kaija-Leena Kolho 11 Charlotte Bergoin 12 Christine Martinez-Vinson 1 Emmanuelle Dugelay 1 Patrizia Alvisi 13 Marina Aloi 14 Erasmo Miele 15 Remi Duclaux-Loras 16 Maria Nachury 17 Jane Languepin 18 Stephanie Willot 19 Claire Dupont-Lucas 20 Alexis Mosca 1 Christos Tzivinikos 21 Ibrahim Shamasneh 22 Sanja Kolaček 2 Jean-Pierre Hugot 1
Abstract : Objectives: Digestive perianastomotic ulcerations (DPAU) resembling Crohn disease lesions are long-term complications of intestinal resections, occurring in children and young adults. They are known to be uncommon, severe and difficult to treat. Methods: In the absence of recommendations, we performed a large European survey among the members of the ESPGHAN working group on inflammatory bowel disease (IBD) in order to collect the experience of expert pediatric gastroenterologists on DPAU. Results: Fifty-one patients (29 boys and 22 girls) were identified from 19 centers in 8 countries. Most patients were followed after necrotizing enterocolitis (n = 20) or Hirschsprung disease (n = 11). The anastomosis was performed at a median age (interquartile range) of 6 [1–23] months, and first symptoms occurred 39 [22–106] months after surgery. Anemia was the most prevalent symptom followed by diarrhea, abdominal pain, bloating, and failure to thrive. Hypoalbuminemia, elevated CRP, and fecal calprotectin were common. Deep ulcerations were found in 59% of patients usually proximally to the anastomosis (68%). During a median follow-up of 40 [19–67] months, treatments reported to be the most effective included exclusive enteral nutrition (31/35, 88%), redo anastomosis (18/22, 82%), and alternate antibiotic treatment (37/64, 58%). Conclusions: Unfortunately, persistence of symptoms, failure to thrive, and abnormal laboratory tests at last follow-up in most of patients show the burden of DPAU lacking optimal therapy and incomplete understanding of the pathophysiology.
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Submitted on : Wednesday, May 11, 2022 - 7:48:47 PM
Last modification on : Saturday, May 14, 2022 - 3:12:24 AM

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Chrystele Madre, Mario Mašić, Daniela Prlenda-Touilleux, Annecarin Brueckner, Sibylle Koletzko, et al.. A European Survey on Digestive Perianastomotic Ulcerations, a Rare Crohn-like Disorder Occurring in Children and Young Adults. Journal of Pediatric Gastroenterology and Nutrition, Lippincott, Williams & Wilkins, 2021, 73 (3), pp.333-337. ⟨10.1097/MPG.0000000000003200⟩. ⟨hal-03662735⟩

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