ArticleJournal of pediatric gastroenterology and nutrition2026
Upper and small bowel Crohn's disease in Brazilian children: Phenotypic characteristic and surgical risk.
Article in Journal of pediatric gastroenterology and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Abstract
objectivesUpper and small bowel Crohn's disease (U-SBCD) represents a clinically aggressive phenotype with high complication rates yet remains diagnostically challenging. In low- and middle-income countries (LMICs), limited inflammatory bowel disease (IBD) awareness contributes to diagnostic delays, but their impact on U-SBCD outcomes remains poorly characterized. We aimed to characterize clinical features, management patterns, and surgical outcomes of pediatric U-SBCD in Brazil, establishing IBD baseline for future regional comparisons in LMIC setting.
methodsThis multicenter retrospective study analyzed 124 pediatric Crohn's disease (CD) patients (diagnosed < 18 years) from six Brazilian centers according to revised PORTO-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) criteria. Patients with U-SBCD (Paris L4a/L4b, n = 39) were compared to non-SBCD (L1/L2/L3). Univariate and multivariable analyses assessed demographics, diagnostic delay, disease behavior, growth impairment, and therapeutic outcomes over 18 months follow-up. The population comprised predominantly African-Brazilian admixture.
resultsU-SBCD patients presented at older age (median 14 vs. 12 years; p = 0.001) with greater height impairment (p = 0.010) and lower body mass index (BMI)/age z-scores (-1.14 vs. -0.44; p = 0.029). Severe weight loss (z-score < -2) conferred 8.3-fold increased U-SBCD odds (95% confidence interval [CI]: 2.17-31.66; p = 0.002). Each year of diagnostic delay increased U-SBCD odds by 22% (95% CI: 1.06-1.39; p = 0.004). U-SBCD patients required more biologic therapy (97% vs. 75%; p = 0.003) with higher treatment escalation rates (31.6% vs. 21.2%; p = 0.004). Multivariate analysis confirmed U-SBCD as an independent three-fold predictor of surgery (OR 3.02; 95% CI: 1.02-8.94; p = 0.046). A 9-year-old girl with U-SBCD died perioperatively. Psychiatric symptoms affected 30% of both groups.
conclusionIn LMIC settings, strengthening medical education is essential to improve early recognition of U-SBCD and prevent progression to irreversible complications. Notably, the phenotypic pattern observed in our study more closely resembled that reported in Asian pediatric patients than Caucasian cohorts.
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