Crohn’s disease diagnosis impacts future health

21 May 2020

By Hudson Institute communications. Reviewed by Dr Edward Giles

Crohn’s disease is an incurable inflammatory bowel disease (IBD) affecting more than 60,000 Australians, including children.

With effective treatment many children with crohn’s disease remain symptom-free for long periods of time. Unfortunately, many still require surgery. It can be difficult for doctors to predict surgery outcomes and sometimes, disease can still recur afterwards.

Detailed diagnosis crucial optimal Crohn’s disease outcome

A large international study of children with Crohn’s disease involving Hudson Institute’s Dr Edward Giles found it was possible to predict if the condition would return after surgery, by studying the findings at their initial gastroscopy—a camera test routine in children, but not adults, with IBD.

Dr Giles, Research Fellow, Regulation of Interferon and Innate Signalling Research group, said the devil is in the detail at diagnosis. He said changes to the bowel only visible under a microscope were predictive of the disease relapsing.

“This study shows that even at diagnosis, subtle findings can have important implications for long term outcomes for children with Crohn’s disease,” Dr Giles said. “It shows that the details can be important, and full assessment at diagnosis can have consequences years down the track.”

Benefits of gastroscopy for Crohn’s disease outcomes

Dr Giles said in most countries, clinicians would only do a colonoscopy for adult patients. He said this research, one of few—and the largest— involving children, showed the benefits of gastroscopy for diagnosis, which can give a better picture of how widespread the damage is to the bowel. He said this could have implications for gaining a deeper understanding of adult patients, as well as children, before surgery.

The study, published in the Journal of Gastroenterology and Hepatology, involved 96 pediatric patients at Royal London Hospital and Massachusetts General Hospital who underwent surgery. It found those with abnormal gastroscopy results—upper gastrointestinal tract inflammation—were associated with the recurrence of disease.

“This was novel, as it can be very difficult to predict which children will do well after surgery, and when the disease will stay away for longer,” Dr Giles said. “Also, this finding, while in children, may be applicable to all people with IBD,” he said.

Predicting outcomes for children with Crohn’s disease

“Our study could help predict outcomes for children with Crohn’s disease, helping decide when surgery is appropriate, and which patients need closer monitoring after surgery for potential relapses.”

Dr Giles said most studies of Crohn’s disease and IBD were conducted in adult patients. However, he said children were arguably more important because they experience a more aggressive form of the disease.

Crohn’s disease can also affect children’s growth and puberty, if it is present early enough, Dr Giles said.

He said the findings were important for family members or friends of people with Crohn’s disease in Australia, and of main interest to doctors who look after IBD patients.

It is the first study ever to find this association with gastroscopy findings.

About inflammatory bowel disease—IBD

IBD is the general term used to describe two different conditions, Crohn’s disease and ulcerative colitis
IBD causes inflammation (damage) in the bowel (intestine)
IBD affects 1 in 200 young people in Australia and has no cure
Crohn’s disease affects more than 60,000 Australians
IBD is sometimes confused with irritable bowel syndrome (IBS) but it is not the same disease and is treated differently
IBD symptoms may include include abdominal pain, diarrhoea, and rectal bleeding
Crohn’s disease can include the above symptoms but may also be accompanied by fever, nausea, vomiting, loss of appetite, poor growth and joint pain.

Collaborators | Monash University, Royal London Hospital, Queen Mary University of London, Massachusetts General Hospital (for children) and Harvard Medical School.

Journal | Journal of Gastroenterology and Hepatology

Title | Histology at diagnostic gastroscopy predicts outcome after intestinal resection in pediatric Crohn's disease

View publication | https://doi.org/10.1111/jgh.15080