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, MAS^a, Alan G. Bostrom, PhD^b, Barbara S. Kirschner, MD^c, George D. Ferry, MD^d, Harland S. Winter, MD^e, Robert N. Baldassano, MD^f, Benjamin D. Gold, MD^g, Oren Abramson, MD^h, Terry Smith, MS^d, Stanley A. Cohen, MD^g and Melvin B. Heyman, MD, MPH^a

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.

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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

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Accepted May 17, 2007.

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