This groundbreaking work is the result of the Crohn’s & Colitis Foundation’s “RISK Stratification” study, the largest new-onset study completed on pediatric Crohn’s disease patients. It is a multicenter research initiative that consists of 25 U.S. institutions and three from Canada and a cohort of 1,112 CD children enrolled at diagnosis, of which 913 were included in the published study. Of the 28 research sites, four are located in Atlanta—Emory University, Georgia Institute of Technology, Children’s Healthcare of Atlanta, and the Children’s Center for Digestive Health Care. The goal of this research was to identify measurable indicators of the two most common complications in pediatric Crohn’s disease that require surgery—stricturing and penetrating disease.
Stricturing, also referred to as fibrostenosis, is characterized by a build-up of fibrotic scar tissue which leads to thickening of the intestinal wall and narrowing of the intestinal passage. Penetrating disease is the result of sustained inflammation that spreads beyond the intestinal wall resulting in the creation of fistulas, abnormal connections between the intestine and other organs. Penetrating complications can also lead to the formation of abscesses at the sites of fistulas.
“Twenty five percent of patients with Crohn’s disease account for 80 percent of complications, hospitalizations, surgery and health care costs. The aim of RISK is to preemptively identify those 25 percent of patients at diagnosis,” Subra Kugathasan, M.D., Emory University, principal investigator and lead author of the paper. “Through the study of baseline gene expression, immune reactivity, and intestinal bacteria, we have identified distinct biological signatures capable of predicting stricturing and penetrating disease, at diagnosis. After analyzing millions of biological and clinical data points, RISK has generated a composite risk stratification model.”