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L. WAUTERS (1), F. SMETS (2), E. DE GREEF (3), I. HOFFMAN (4), P. BONTEMS (5), S. VAN BIERVLIET (6), E. VAN DE VIJVER (7), I. PAQUOT (8), P. ALLIET (9), W. ARTS (10), B. HAUSER (11), H. PEETERS (12), M. DE VOS (13), P. BOSSUYT (14), J. RAHIER (15), O. DEWIT (16), O. DEWIT (16), T. MOREELS (16), F. FONTAINE (17), E. LOUIS (17), D. FRANCHIMONT (18), V. MULS (18), J. COCHE (19), F. BAERT (20), S. VERMEIRE (1), G. VEEREMAN (11) / [1] University Hospitals Leuven, Leuven, Belgium, Gastroenterology and Hepatology, [2] Clin universitaires St-Luc, UCL, Brussels, Belgium, Paediatric Gastroenterology, [3] UZ Brussel, Jette, Belgium, Paediatric Gastroenterology, [4] University Hospitals Leuven, Leuven, Belgium, Paediatric Gastroenterology, [5] HUDERF, City of Brussels, Belgium, Paediatric Gastroenterology, [6] UZ Gent, Gent, Belgium, Paediatric Gastroenterology, [7] UZ Antwerpen, Antwerp, Belgium, , Belgium, Pediatric Gastroenterology, [8] CHC Clinique de l'Esperance, Liège, Belgium, Paediatric Gastroenterology, [9] Jessa Hospital, Hasselt, Belgium, Paediatric Gastroenterology, [10] ZOL, Genk, Belgium, Paediatric Gastroenterology, [11] UZ Brussel, Jette, Belgium, Pediatric Gastroenterology, [12] AZ St Lucas, Ghent, Belgium, Gastroenterology, [13] UZ Gent, Gent, Belgium, Gastroenterology, [14] Imelda Hospital, Bonheiden, Belgium, Gastroenterology, [15] UCL, Mont-Godinne, Belgium, Gastroenterology, [16] Clin universitaires St-Luc, UCL, Brussels, Belgium, Gastroenterology, [17] CHU Liege, Liège, Belgium, Gastroenterology, [18] ULB Hôpital Erasme, Brussels, Belgium, Gastroenterology, [19] Clinique St. Pierre, Ottignies, Belgium, Gastroenterology, [20] Heilig Hart Ziekenhuis, Roeselare, Belgium, Gastroenterology Introduction The prolonged use of biologic agents with or without immunomodulators (IM) remains controversial in the management of paediatric Crohn’s disease (CD). Aim The prolonged use of biologic agents with or without immunomodulators (IM) remains controversial in the man

L. WAUTERS (1), F. SMETS (2), E. DE GREEF (3), P. BONTEMS (4), I. HOFFMAN (5), P. ALLIET (6), W. ARTS (7), S. VAN BIERVLIET (8), I. PAQUOT (9), E. VAN DE VIJVER (10), B. HAUSER (3), H. PEETERS (11), M. DE VOS (12), P. BOSSUYT (13), J. RAHIER (14), T. MOREELS (15), O. DEWIT (15), D. FRANCHIMONT (16), V. MULS (16), F. FONTAINE (17), E. LOUIS (17), J. COCHE (18), F. BAERT (19), S. VERMEIRE (20), G. VEEREMAN (3) / [1] University Hospitals Leuven, Leuven, Belgium, Gastroenterology and Hepatology, [2] Clin universitaires St-Luc, UCL, Brussels, Belgium, Pediatric Gastroenterology, [3] UZ Brussel, Jette, Belgium, Pediatric Gastroenterology, [4] HUDERF, City of Brussels, Belgium, Pediatric Gastroenterology, [5] University Hospitals Leuven, Leuven, Belgium, Pediatric Gastroenterology, [6] Jessa Hospital, Hasselt, Belgium, Pediatric Gastroenterology, [7] ZOL, Genk, Belgium, Pediatric Gastroenterology, [8] UZ Gent, Gent, Belgium, Pediatric Gastroenterology, [9] CHC, Liège, Belgium, Pediatric Gastroenterology, [10] UZ Antwerpen, Antwerp, Belgium, , Belgium, Pediatric Gastroenterology, [11] AZ St Lucas, Ghent, Belgium, Gastroenterology, [12] UZ Gent, Gent, Belgium, Gastroenterology, [13] Imelda Hospital, Bonheiden, Belgium, Gastroenterology, [14] UCL, Mont-Godinne, Belgium, Gastroenterology, [15] Clin universitaires St-Luc, UCL, Brussels, Belgium, Gastroenterology, [16] ULB Hôpital Erasme, Brussels, Belgium, Gastroenterology, [17] CHU Liege, Liège, Belgium, Gastroenterology, [18] Clinique St. Pierre, Ottignies, Belgium, Gastroenterology, [19] Heilig Hart Ziekenhuis, Roeselare, Belgium, Gastroenterology, [20] University Hospitals Leuven, Leuven, Belgium, Gastroenterology Introduction Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between treating physician and centre of care. Aim Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between treating physician and centre of care. Methods Data from the BELCRO, an observati

AIM: A Belgian registry for pediatric Crohn's disease, BELCRO, was created. This first report aims at describing disease presentation and phenotype and determining associations between variables at diagnosis and registration in the database. METHODS: Through a collaborative network, children with previously established Crohn's disease and newly diagnosed children and adolescents (under 18 y of age) were recruited over a 2 year period. Data were collected by 23 centers and entered in a database. Statistical association tests analyzed relationships between variables of interest at diagnosis. RESULTS: Two hundred fifty-five patients were included. Median age at diagnosis was 12.5 y (range: 1.6-18 y); median duration of symptoms prior to diagnosis was 3 m (range: 1-12 m). Neonatal history and previous medical history did not influence disease onset nor disease behavior. Fifty three % of these patients presented with a BMI z-score < -1. CRP was an independent predictor of disease severity. Steroids were widely used as initial treatment in moderate to severe and extensive disease. Over time, immunomodulators and biological were prescribed more frequently, reflecting a lower prescription rate for steroids and 5-ASA. A positive family history was the sole significant determinant for earlier use of immunosuppression. CONCLUSION: In Belgium, the median age of children presenting with Crohn's disease is 12.5 y. Faltering growth, extensive disease and upper GI involvement are frequent. CRP is an independent predictive factor of disease activity. A positive family history appears to be the main determinant for initial treatment choice.

Biologicals have become an important component in the treatment of Crohn's disease in children. Their increased and long term use raises safety concerns. We describe safety and cost of infliximab in Belgian pediatric Crohn's disease patients. All patients on infliximab as part of the present or past treatment for Crohn's Disease until January 1st 2011 were selected from an existing database. Information on disease phenotype, medication and adverse events were extracted. Adverse events occurred in 25.9% of patients exposed to infliximab of which 29.6% were severe. In total 31.7% of patients stopped infliximab therapy. The main reasons for discontinuation were adverse events in 45.4% and loss of response in 30.3%. No malignancies or lethal complications occurred over this 241 patient year observation period. Immunomodulators were concomitant medication in 75% of patients and were discontinued subsequently in 38.4% of them. The cost of infliximab infusions per treated patient per year in the Belgian health care setting is approximately 9 474 euro, including only medication and hospital related costs. Even though infliximab is relatively safe in pediatric CD on the short term, close follow-up and an increased awareness of the possible adverse reactions is highly recommended. Adverse reactions appeared in 25.9% of all patients and were the main reason for discontinuation. Treatment cost has to be balanced against efficacy and modifications in disease course. In the Belgian health care system, the medication is available to all patients with moderate to severe CD.