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. 2021 Sep 1;73(3):333-337.
doi: 10.1097/MPG.0000000000003200.

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   5 , Alexandre Fabre  6   7 , Jérome Viala  8   9 , Rosa Lima  10 , Raphael Enaud  11 , Julie Lemale  12 , Kaija-Leena Kolho  13 , Charlotte Bergoin  14 , Christine Martinez-Vinson  8 , Emmanuelle Dugelay  8 , Patrizia Alvisi  15 , Marina Aloi  16 , Erasmo Miele  17 , Remi Duclaux-Loras  18 , Maria Nachury  19 , Jane Languepin  20 , Stephanie Willot  21 , Claire Dupont-Lucas  22   23 , Alexis Mosca  8 , Christos Tzivinikos  24 , Ibrahim Shamasneh  25 , Sanja Kolaček  2 , Jean-Pierre Hugot  8   9 ; pediatric GETAID group and the ESPGHAN IBD Porto group
Affiliations

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

Chrystele Madre et al. J Pediatr Gastroenterol Nutr. .

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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Conflict of interest statement

The authors report no conflicts of interest.

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