Considerable debate exists as to whether the risk of complications and need for surgery has truly decreased in Crohn's disease (CD) over time. A recent systematic review and meta-analysis reported that after the year 2000, the surgical rates at 1, 5 and 10 years have significantly decreased. It is unclear whether this decrease can be solely attributable to the introduction of biologics, the more effective use of thiopurine dosing with monitoring or perhaps earlier disease recognition and early use of effective interventions. Uncontrolled observational studies confirmed that scheduled maintenance treatment with anti-TNF as compared to episodic or discontinued use of anti-TNF resulted in fewer surgeries. Recent population-based studies have shown similar improved disease outcomes with early immunomodulator use. There is a dearth of pediatric-specific natural history studies for both short and long term. Multiple pediatric observational cohort studies have reported that up to one third of pediatric-onset CD patients progress to surgery within 5 years. This is a slightly higher proportion than that of adult patients followed in the same time frame. This discrepancy may be explained by less early biologic use in pediatric patients. More data are needed to follow all CD patients for longer follow-up periods with an emphasis on pediatric onset to better gauge whether our proposed treatment strategies are actually altering the natural history of disease and what role biologics play in this regard.

Keywords:
Biologics, Crohn’s disease, Pediatrics, Surgery
1.
Frolkis AD, Dykeman J, Negrón ME, deBruyn J, Jette N, Fiest KM, Frolkis T, Barkema HW, Rioux KP, Panaccione R, Ghosh S, Wiebe S, Kaplan GG: Risk of surgery for the inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 2013;145:996-1006.
2.
Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, Gendre JP: Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis 2002;8:244-250.
3.
Binder V, Hendriksen C, Kreiner S: Prognosis in Crohn's disease - based on results from a regional patient group from the county of Copenhagen. Gut 1985;26:146-150.
4.
Vernier-Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, Merle V, Salomez JL, Branche J, Marti R, Lerebours E, Cortot A, Gower-Rousseau C, Colombel JF: Natural history of pediatric Crohn's disease: a population-based cohort study. Gastroenterology 2008;135:1106-1113.
5.
Boualit M, Salleron J, Turck D, Fumery M, Savoye G, Dupas JL, Lerebours E, Duhamel A, Merle V, Cortot A, Colombel JF, Peyrin-Biroulet L, Gower-Rousseau C; EPIMAD Group: Long-term outcome after first intestinal resection in pediatric-onset Crohn's disease: a population-based study. Inflamm Bowel Dis 2013;19:7-14.
6.
Aloi M, Viola F, D'Arcangelo G, Di Nardo G, Civitelli F, Casciani E, Oliva S, Nuti F, Dilillo A, Cucchiara S: Disease course and efficacy of medical therapy in stricturing paediatric Crohn's disease. Dig Liver Dis 2013;45:464-468.
7.
Lau CC, Dubinsky MC, Melmed GY, Vasiliauskas EA, McGovern DP, Berel D, Murrell ZR, Ippoliti A, Shih DQ, Kaur M, Targan SR, Fleshner P: Influence of biologic agents on short-term postoperative complications in patients with Crohn's disease: a prospective, single-surgeon cohort study. Gastroenterology 2013;144(suppl 1):407.
8.
Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J: Predictors of Crohn's disease. Gastroenterology 2006;130:650-656.
9.
Desir B, Amre DK, Lu SE, Ohman-Strickland P, Dubinsky M, Fisher R, Seidman EG: Utility of serum antibodies in determining clinical course in pediatric Crohn's disease. Clin Gastroenterol Hepatol 2004;2:139-146.
10.
Dubinsky MC, Kugathasan S, Mei L, Picornell Y, Nebel J, Wrobel I, Quiros JA, Silber G, Wahbeh G, Katzir L, Vasiliauskas EA, Bahar RJ, Otley A, Mack DR, Evans J, Rosh JR, Hemker MO, Leleiko NS, Crandall WV, Langton C, Landers C, Taylor KD, Targan SR, Rotter JI, Markowitz JF, Hyams JS; Western Regional Pediatric IBD Research Alliance; Pediatric IBD Collaborative Research Group; Wisconsin Pediatric IBD Alliance: Increased immune reactivity predicts aggressive complicating Crohn's disease in children. Clin Gastroenterol Hepatol 2008;6:1105-1111.
11.
Amre DK, Lu SE, Costea F, Seidman EG: Utility of serological markers in predicting the early occurrence of complications and surgery in pediatric Crohn's disease patients. Am J Gastroenterol 2006;101:645-652.
12.
Annese V, Lombardi G, Perri F, D'Inca R, Ardizzone S, Riegler G, Giaccari S, Vecchi M, Castiglione F, Gionchetti P, Cocchiara E, Vigneri S, Latiano A, Palmieri O, Andriulli A: Variants of CARD15 are associated with an aggressive clinical course of Crohn's disease - an IG-IBD study. Am J Gastroenterol 2005;100:84-92.
13.
Siegel CA, Siegel LS, Hyams JS, Kugathasan S, Markowitz J, Rosh JR, Leleiko N, Mack DR, Crandall W, Evans J, Keljo DJ, Otley AR, Oliva-Hemker M, Farrior S, Langton CR, Wrobel IT, Wahbeh G, Quiros JA, Silber G, Bahar RJ, Sands BE, Dubinsky MC: Real-time tool to display the predicted disease course and treatment response for children with Crohn's disease. Inflamm Bowel Dis 2011;17:30-38.
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2014
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