Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1418-e1425 (doi:10.1542/peds.2007-0905)
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ARTICLE

Gender Differences in Presentation and Course of Disease in Pediatric Patients With Crohn Disease

Neera Gupta, MD, MASa, Alan G. Bostrom, PhDb, Barbara S. Kirschner, MDc, George D. Ferry, MDd, Harland S. Winter, MDe, Robert N. Baldassano, MDf, Benjamin D. Gold, MDg, Oren Abramson, MDh, Terry Smith, MSd, Stanley A. Cohen, MDg and Melvin B. Heyman, MD, MPHa

Departments of a Pediatrics
b Epidemiology and Biostatistics, University of California, San Francisco, California
c Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, Illinois
d Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
e Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
f Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
g Department of Pediatrics, Emory University School of Medicine and Children's Center for Digestive Healthcare, Children's Healthcare of Atlanta, Atlanta, Georgia
h Kaiser Permanente of Northern California, Oakland, California

OBJECTIVE. The objective of this study was to determine gender differences in pediatric patients with Crohn disease.

METHODS. We conducted a retrospective cohort study of 989 consecutive pediatric patients (566 boys, 423 girls) who had Crohn disease (aged 0 to 17 years at diagnosis) by using the Pediatric IBD Consortium Registry. Uniform data were analyzed to compare the presentation and course of disease according to gender.

RESULTS. Median follow-up time was 2.8 years. Mean ± SD age at diagnosis of inflammatory bowel disease (11.5 ± 3.8 years) did not differ by gender. Compared with boys, girls had a higher prevalence of mouth sores at symptom onset and a higher prevalence of hypoalbuminemia at the time of diagnosis. Location of disease did not differ by gender. A higher proportion of girls had abnormal anti–outer membrane porin of Escherichia coli levels compared with boys. Girls were at increased risk for erythema nodosum/pyoderma gangrenosum and decreased risk for growth failure compared with boys.

CONCLUSIONS. Girls appear to have an overall more severe course of disease; however, boys are at increased risk for developing growth failure. Disease course and the impact of disease severity on growth according to gender in pediatric Crohn disease require prospective study.

Key Words: inflammatory bowel disease • growth failure • epidemiology • database • medications • complications • surgery • erythema nodosum • pyoderma gangrenosum

Abbreviations: CD—Crohn disease • IBD—inflammatory bowel disease • PCDAI—Pediatric Crohn's Disease Activity Index • ESR—erythrocyte sedimentation rate • OmpC—outer membrane porin of Escherichia coli • WBC—white blood cell • 5-ASA—5-aminosalicylic acid • OR—odds ratio • HR—hazard ratio • CI—confidence interval

Accepted May 17, 2007.