Official journal of the American College of Gastroenterology

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name="wkhealth_issue" content="9" /><meta name="wkhealth_article_publication_date" content="April 25, 2023" /><meta name="wkhealth_volume" content="118" /><meta name="wkhealth_ovid_accession_number" content="00000434-202309000-00027" /><meta name="wkhealth_issn" content="0002-9270" /><meta name="wkhealth_title" content="Natural History of Anal Ulcerations in Pediatric-Onset Crohn's Disease: Long-Term Follow-Up of a Population-Based Study" /><meta name="wkhealth_authors" content="Mortreux, Perrine;Leroyer, Ariane;Dupont, Claire;Ley, Delphine;Bertrand, Valérie;Spyckerelle, Claire;Guillon, Nathalie;Wils, Pauline;Gower-Rousseau, Corinne;Savoye, Guillaume;Fumery, Mathurin;Turck, Dominique;Siproudhis, Laurent;Sarter, Hélène" /><meta name="wkhealth_doi" content="10.14309/ajg.0000000000002301" /><meta name="wkhealth_abstract_html_url" content="https://journals.lww.com/ajg/abstract/2023/09000/natural_history_of_anal_ulcerations_in.27.aspx" /><meta name="wkhealth_fulltext_html_url" content="https://journals.lww.com/ajg/fulltext/2023/09000/natural_history_of_anal_ulcerations_in.27.aspx" /><meta name="wkhealth_toc_section" content="ARTICLES" /><meta name="wkhealth_toc_sub_section" content="PEDIATRICS" /><meta name="wkhealth_eJpId" content="ajg:2023:09000:00027" /><meta name="wkhealth_firstpage" content="1671" /><meta name="wkhealth_date" content="September 2023" /><meta name="wkhealth_pdf_url" content="https://journals.lww.com/ajg/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=Other&an=00000434-202309000-00027" /><meta name="Description" content="INTRODUCTION: Anal ulcerations are frequently observed in Crohn's disease (CD). However, their na" /><meta property="og:site_name" content="LWW" /><meta property="og:type" content="article" /><meta property="og:title" content="Natural History of Anal Ulcerations in Pediatric-Onset... : Official journal of the American College of Gastroenterology | ACG" /><meta property="og:description" content="registry EPIMAD were followed retrospectively until 2013. At diagnosis and during follow-up, the clinical and therapeutic features of perianal disease were recorded. An adjusted time-dependent Cox model was used to evaluate the risk of evolution of anal ulcerations toward suppurative lesions. RESULTS: Among the 1,005 included patients (females, 450 [44.8%]; median age at diagnosis 14.4 years [interquartile range 12.0–16.1]), 257 (25.6%) had an anal ulceration at diagnosis. Cumulative incidence of anal ulceration at 5 and 10 years from diagnosis was 38.4% (95% confidence interval [CI] 35.2–41.4) and 44.0% (95% CI 40.5–47.2), respectively. In multivariable analysis, the presence of extraintestinal manifestations (hazard ratio [HR] 1.46, 95% CI 1.19–1.80, P = 0.0003) and upper digestive location (HR 1.51, 95% CI 1.23–1.86, P < 0.0001) at diagnosis were associated with the occurrence of anal ulceration. Conversely, ileal location (L1) was associated with a lower risk of anal ulceration (L2 vs L1 HR 1.51, 95% CI 1.11–2.06, P = 0.0087; L3 vs L1 HR 1.42, 95% CI 1.08–1.85, P = 0.0116). The risk of fistulizing perianal CD (pCD) was doubled in patients with a history of anal ulceration (HR 2.00, 95% CI 1.45–2.74, P < 0.0001). Among the 352 patients with at least 1 episode of anal ulceration without history of fistulizing pCD, 82 (23.3%) developed fistulizing pCD after a median follow-up of 5.7 years (interquartile range 2.8–10.6). In these patients with anal ulceration, the diagnostic period (pre vs biologic era), exposure to immunosuppressants, and/or anti–tumor necrosis factor did not influence the risk of secondary anoperineal suppuration. DISCUSSION: Anal ulceration is frequent in pediatric-onset CD, with nearly half of patients presenting with at least 1 episode after 10 years of evolution. Fistulizing pCD is twice as frequent in patients with present or past anal ulceration...." /><meta property="og:image" content="https://images.journals.lww.com/ajg/SocialThumb.00000434-202309000-00027.T1.jpeg" /><meta property="og:image:width" content="1005" /><meta property="og:image:height" content="2505" /><meta property="og:url" content="https://journals.lww.com/ajg/fulltext/2023/09000/natural_history_of_anal_ulcerations_in.27.aspx" /><meta property="twitter:card" content="summary" /><meta name="robots" content="index, follow, noarchive" /><meta name="WT.sv" content="ZUSE1PEJPWEB02" /><meta name="Title" content="Official journal of the American College of Gastroenterology | ACG" /><style id="SPThemeHideForms" type="text/css">body {opacity:0 !important}</style>  <link href="https://fonts.googleapis.com/css?family=Arvo:400,400i,700|Fira+Sans:300,300i,400,400i,500,500i,600,600i,700,700i&display=swap" rel="stylesheet" /> <script> // temporary workaround for Bug 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GY5MTNjMmItM2MwNS00MjNmLTk1ZDItMmM5OWRkMjVjYTdmIiBjbGFzcz0iYWQtc2xvdC1jb250YWluZXIgYWQtc2xvdC1jb250YWluZXItZ2FfNGY5MTNjMmItM2MwNS00MjNmLTk1ZDItMmM5OWRkMjVjYTdmIiBkYXRhLXNpemVtYXA9IltbWzAsIDBdLCBbWzMwMCwgMjUwXV1dXSIgZGF0YS1hZHBhdGg9Ii8xNTcyNjcwMjc2MS9EZXNrdG9wL2FqZy9BcnRpY2xlL1JpZ2h0IiBkYXRhLWF1dG9sb2FkPSJubyIgZGF0YS1vdXRvZnBhZ2U9Im5vIiBkYXRhLXN0aWNreT0ibm8iIGRhdGEtc2xvdHRhcmdldGluZz0nJyBkYXRhLWRpc3BsYXlzbHVnPSJ5ZXMiIGRhdGEtc3RpY2t5LWR1cmF0aW9uPSIwIiBkYXRhLW5hbWU9IlJpZ2h0Ij48L2Rpdj4fAGdkBSZnXzYzYzYzYmE2X2ViMGFfNGQ1MV9hZjljX2NjMzA5NGJmM2M4Yw9kFgRmDxYEHwNkHywFWnsic2VydmljZVVybCI6bnVsbCwiZGlzcGxheU1vZGUiOm51bGwsImhhc2giOiIxIiwiaXRlbXNQZXJQYWdlIjo0MCwicmVuZGVyT25TZXJ2ZXIiOmZhbHNlfWQCAQ9kFgJmD2QWAmYPFCsAAg8WBB8mZx8nAgVkZGQFJmdfOTVhMmU5OTlfY2Q2N180N2FhXzk5MDhfMGU3YTk1ZjFhZjJmD2QWAmYPZBYCAgIPFgQfAwUtZWotYWR2ZXJ0aXNlbWVudCBlai1hZHZlcnRpc2VtZW50LWJhbm5lcmNvbWJvHwBnFgICAQ8WBB8CBd8DPGRpdiBpZD0iZ2FfYzYwMzNlOTYtZTk1MC00ZDZkLTg1NmMtMjhhZTQzMWE2MGE0IiBjbGFzcz0iYWQtc2xvdC1jb250YWluZXIgYWQtc2xvdC1jb250YWluZXItZ2FfYzYwMzNlOTYtZTk1MC00ZDZkLTg1NmMtMjhhZTQzMWE2MGE0IiBkYXRhLXNpemVtYXA9IltbWzEwNTAsIDIwMF0sIFtbMzAwLCA2MDBdLCBbMzAwLCAyNTBdLCBbMTYwLCA2MDBdXV0sIFtbNzMwLCA2MDBdLCBbWzMwMCwgNjAwXSwgWzMwMCwgMjUwXV1dLCBbIFsgMCwgMCBdLCBbIFszMDAsIDI1MF0gXSBdIF0iIGRhdGEtYWRwYXRoPSIvMTU3MjY3MDI3NjEvRGVza3RvcC9hamcvQXJ0aWNsZS9SaWdodDEiIGRhdGEtYXV0b2xvYWQ9Im5vIiBkYXRhLW91dG9mcGFnZT0ibm8iIGRhdGEtc3RpY2t5PSJubyIgZGF0YS1zbG90dGFyZ2V0aW5nPScnIGRhdGEtZGlzcGxheXNsdWc9InllcyIgZGF0YS1zdGlja3ktZHVyYXRpb249IjAiIGRhdGEtbmFtZT0iUmlnaHQxIj48L2Rpdj4fAGdkAgkPFgIfAGgWAgIFD2QWAgIDDxYCHwBoFgJmD2QWBAICD2QWBgIBDxYCHwBoZAIDDxYCHwBoZAIFDxYCHwBoZAIDDw8WAh4JQWNjZXNzS2V5BQEvZGQCCw9kFgICAQ8PFgIfAGhkZAITD2QWAgIBD2QWAmYPZBYCAgIPFgQfAwUqZWotYWR2ZXJ0aXNlbWVudCBlai1hZHZlcnRpc2VtZW50LXRvcGNvbWJvHwBnFgICAQ8WBB8CBZEDPGRpdiBpZD0iZ2FfNGZhNjY5MzctYzVhMC00NGM5LWJlZDItYjBhYTQ1MjdiYmQzIiBjbGFzcz0iYWQtc2xvdC1jb250YWluZXIgYWQtc2xvdC1jb250YWluZXItZ2FfNGZhNjY5MzctYzVhMC00NGM5LWJlZDItYjBhYTQ1MjdiYmQzIiBkYXRhLXNpemVtYXA9IltbWzczMCwgNTAwXSwgW1s3MjgsIDkwXV1dLCBbWzAsIDBdLCBbWzMwMCwgNTBdXV1dIiBkYXRhLWFkcGF0aD0iLzE1NzI2NzAyNzYxL0Rlc2t0b3AvYWpnL0FydGljbGUvVG9wIiBkYXRhLWF1dG9sb2FkPSJ5ZXMiIGRhdGEtb3V0b2ZwYWdlPSJubyIgZGF0YS1zdGlja3k9InllcyIgZGF0YS1zbG90dGFyZ2V0aW5nPScnIGRhdGEtZGlzcGxheXNsdWc9InllcyIgZGF0YS1zdGlja3ktZHVyYXRpb249IjUiIGRhdGEtbmFtZT0iVG9wIj48L2Rpdj4fAGdkAhUPZBYCZg9kFhBmD2QWBGYPZBYMAgEPFgIfAGgWBAIDD2QWEAIBDxYCHwBoFgICAQ8PFgIfKwWVAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvc2VjdXJlL3BhZ2VzL215YWNjb3VudC5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDkwMDAlMmZuYXR1cmFsX2hpc3Rvcnlfb2ZfYW5hbF91bGNlcmF0aW9uc19pbi4yNy5hc3B4ZGQCAw8WAh8AaBYCAgEPDxYCHysFtgFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3NlY3VyZS9wYWdlcy9teWFjY291bnQuYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmFic3RyYWN0JTJmMjAyMyUyZjA5MDAwJTJmbmF0dXJhbF9oaXN0b3J5X29mX2FuYWxfdWxjZXJhdGlvbnNfaW4uMjcuYXNweCZlZGl0V2ViUGFydD1lZGl0Q2hhbmdlUGFzc3dvcmRXUGRkAgUPFgIfAGgWAgIBDw8WAh8rBZcBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9zZWN1cmUvcGFnZXMvbXlmYXZvcml0ZXMuYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmFic3RyYWN0JTJmMjAyMyUyZjA5MDAwJTJmbmF0dXJhbF9oaXN0b3J5X29mX2FuYWxfdWxjZXJhdGlvbnNfaW4uMjcuYXNweGRkAgcPZBYCAgEPDxYCHysFsAFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3NlY3VyZS9wYWdlcy9teWZhdm9yaXRlcy5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDkwMDAlMmZuYXR1cmFsX2hpc3Rvcnlfb2ZfYW5hbF91bGNlcmF0aW9uc19pbi4yNy5hc3B4JmNvbGxlY3Rpb249U2F2ZWRTZWFyY2hlc2RkAgsPZBYCAgEPDxYCHysFjQFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3BhZ2VzL3JlZ2lzdGVyLmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZhYnN0cmFjdCUyZjIwMjMlMmYwOTAwMCUyZm5hdHVyYWxfaGlzdG9yeV9vZl9hbmFsX3VsY2VyYXRpb25zX2luLjI3LmFzcHhkZAIND2QWAgIBDxYCHwEFGWh0dHA6Ly9oZWFsdGhqb2JzcGx1cy5jb21kAg8PFgIfAGcWAgIBDw8WBh8rBaoBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9wYWdlcy9sb2dpbi5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDkwMDAlMmZuYXR1cmFsX2hpc3Rvcnlfb2ZfYW5hbF91bGNlcmF0aW9uc19pbi4yNy5hc3B4JlJlcXVlc3RGb3I9QWN0aXZhdGVTdWJzY3JpcHRpb24eB0VuYWJsZWRnHwBnZGQCEw8WAh8AaBYCAgEPDxYCHysFiQFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL19sYXlvdXRzLzE1L29ha3Muam91cm5hbHMvbG9nb3V0LmFzcHg/Q29udGV4dFVybD1odHRwcyUzYSUyZiUyZmpvdXJuYWxzLmx3dy5jb20lMmZhamclMmZwYWdlcyUyZmRlZmF1bHQuYXNweGRkAgUPFgIfAGgWAgIBDxQrAAJkZGQCAw8WAh8AZ2QCBA9kFgICAQ8PFggfJAUgdXNlci1tZW51X19saW5rIGpzLXJlZ2lzdGVyLWxpbmsfKwWNAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmFic3RyYWN0JTJmMjAyMyUyZjA5MDAwJTJmbmF0dXJhbF9oaXN0b3J5X29mX2FuYWxfdWxjZXJhdGlvbnNfaW4uMjcuYXNweB8lAgIfAGcWAh8sBVR7ImV2ZW50TmFtZSI6IlJlZ2lzdGVyIiwiZXZlbnREZXRhaWwiOnsic291cmNlIjoiTWFzdGhlYWQgRHJvcGRvd24ifSwiaXNOdWxsIjpmYWxzZX1kAgUPFgIfAGcWAgIBDw8WAh8rBSBodHRwczovL3Nob3AubHd3LmNvbS9wLzAwMDItOTI3MGRkAggPFgIfAGhkAgsPZBYCAgYPZBYCAgEPZBYCAgUPDxYEHysFQGh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvX2xheW91dHMvb2Frcy5qb3VybmFscy9wcml2YWN5LmFzcHgfAgUOUHJpdmFjeSBQb2xpY3lkZAIBD2QWBmYPEA8WBh4NRGF0YVRleHRGaWVsZAUEVGV4dB4ORGF0YVZhbHVlRmllbGQFBFRleHQfJmdkEBUGA0FsbAhBcnRpY2xlcwZJbWFnZXMGVmlkZW9zCFBvZGNhc3RzBUJsb2dzFQYDQWxsCEFydGljbGVzBkltYWdlcwZWaWRlb3MIUG9kY2FzdHMFQmxvZ3MUKwMGZ2dnZ2dnZGQCBQ8PFgIfKwU2aHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9wYWdlcy9hZHZhbmNlZHNlYXJjaC5hc3B4ZGQCBg8PFgIfLmhkZAIBDw8WAh8rBSBodHRwczovL3Nob3AubHd3LmNvbS9wLzAwMDItOTI3MGRkAgIPDxYCHysFjQFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3BhZ2VzL3JlZ2lzdGVyLmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZhYnN0cmFjdCUyZjIwMjMlMmYwOTAwMCUyZm5hdHVyYWxfaGlzdG9yeV9vZl9hbmFsX3VsY2VyYXRpb25zX2luLjI3LmFzcHhkZAIDDw8WBB8rBZUBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9zZWN1cmUvcGFnZXMvbXlhY2NvdW50LmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZhYnN0cmFjdCUyZjIwMjMlMmYwOTAwMCUyZm5hdHVyYWxfaGlzdG9yeV9vZl9hbmFsX3VsY2VyYXRpb25zX2luLjI3LmFzcHgfAGhkZAIEDw8WAh8AaBYCHyIFImJvcmRlci1yaWdodDoxcHggc29saWQgIWltcG9ydGFudDtkAgYPDxYCHysFiQFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL19sYXlvdXRzLzE1L29ha3Muam91cm5hbHMvbG9nb3V0LmFzcHg/Q29udGV4dFVybD1odHRwcyUzYSUyZiUyZmpvdXJuYWxzLmx3dy5jb20lMmZhamclMmZwYWdlcyUyZmRlZmF1bHQuYXNweBYCHyIFImJvcmRlci1yaWdodDoxcHggc29saWQgIWltcG9ydGFudDtkAgcPFgIfLAW5AXsiYnJvd3NpbmdIaXN0b3J5Ijp7ImlzRW5hYmxlZCI6dHJ1ZSwic2VydmljZVVybCI6Imh0dHBzOi8vYXBpbS1obHJwLWVqcC1wcm9kLmF6dXJlLWFwaS5uZXQvZWUiLCJwZGZEb3dubG9hZFVybCI6Ii9fbGF5b3V0cy8xNS9vYWtzLmpvdXJuYWxzL2Rvd25sb2FkcGRmLmFzcHg/dHJja25nX3NyY19wZz1IaXN0b3J5VGFiIn19ZAIKD2QWBmYPEA8WBh8vBQRUZXh0HzAFBFRleHQfJmdkEBUGA0FsbAhBcnRpY2xlcwZJbWFnZXMGVmlkZW9zCFBvZGNhc3RzBUJsb2dzFQYDQWxsCEFydGljbGVzBkltYWdlcwZWaWRlb3MIUG9kY2FzdHMFQmxvZ3MUKwMGZ2dnZ2dnZGQCBQ8PFgIfKwU2aHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9wYWdlcy9hZHZhbmNlZHNlYXJjaC5hc3B4ZGQCBg8PFgIfLmhkZAIhD2QWAmYPZBYcAgEPZBYCZg9kFgJmD2QWCAIBDxYCHykFUGh0dHBzOi8vaW1hZ2VzLmpvdXJuYWxzLmx3dy5jb20vYWpnL1hMYXJnZVRodW1iLjAwMDAwNDM0LTIwMjQxMTAwMC0wMDAwMC5DVi5qcGVnZAIDDxYCHyoFE05ldmVyIE1pc3MgYW4gSXNzdWVkAgUPFgIfKgVBR2V0IG5ldyBqb3VybmFsIFRhYmxlcyBvZiBDb250ZW50cyBzZW50IHJpZ2h0IHRvIHlvdXIgZW1haWwgaW5ib3hkAgkPFgYeD2RhdGEtYWxlcnQtdHlwZQUERXRvYx4TZGF0YS1zdWJzY3JpYmVkLW1zZwVPWW91IGFyZSBub3cgc3Vic2NyaWJlZCB0byByZWNlaXZlIGVUT0MgYWxlcnRzIHdoZW5ldmVyIG5ldyBpc3N1ZXMgYXJlIHB1Ymxpc2hlZB8qBRRHZXQgTmV3IElzc3VlIEFsZXJ0c2QCAw9kFggCAQ8UKwACDxYEHyZnHycCBWRkFgpmD2QWAmYPFQMqL2FqZy9wYWdlcy92aWV3YWxsbW9zdHBvcHVsYXJhcnRpY2xlcy5hc3B4AAxNb3N0IFBvcHVsYXJkAgEPZBYCZg8VAzsvYWpnL19sYXlvdXRzLzEwMzMvb2Frcy5qb3VybmFscy9pbmZvcm1hdGlvbmZvcmF1dGhvcnMuYXNweAALRm9yIEF1dGhvcnNkAgIPZBYCZg8VAx8vYWpnL3BhZ2VzL2Fib3V0dGhlam91cm5hbC5hc3B4ABFBYm91dCB0aGUgSm91cm5hbGQCAw9kFgJmDxUDGS9hamcvcGFnZXMvaXNzdWVsaXN0LmFzcHgAC1Bhc3QgSXNzdWVzZAIED2QWAmYPFQMaL2FqZy9wYWdlcy9jdXJyZW50dG9jLmFzcHgADUN1cnJlbnQgSXNzdWVkAgMPZBYCZg8PFgIfKwWNAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmFic3RyYWN0JTJmMjAyMyUyZjA5MDAwJTJmbmF0dXJhbF9oaXN0b3J5X29mX2FuYWxfdWxjZXJhdGlvbnNfaW4uMjcuYXNweGRkAgUPFgIfAGcWAmYPDxYCHysFIGh0dHBzOi8vc2hvcC5sd3cuY29tL3AvMDAwMi05MjcwZGQCCQ8WAh8AaBYCAgEPFCsAAmRkZAIFD2QWDgIBD2QWAgIBDxQrAAIPFgQfJmcfJwICZGQWBGYPZBYCZg8VBAA+L2FqZy9fbGF5b3V0cy8xNS8xMDMzL29ha3Muam91cm5hbHMvaW5mb3JtYXRpb25mb3JhdXRob3JzLmFzcHgAEVN1Ym1pdCBhbiBhcnRpY2xlZAIBD2QWAmYPFQQAJWh0dHBzOi8vd2thdXRob3JzZXJ2aWNlcy5lZGl0YWdlLmNvbS8GX2JsYW5rFkhvdyB0byBwdWJsaXNoIHdpdGggdXNkAgUPFgIfJwIEFghmD2QWAmYPFQQaZWpwLWZvb3Rlci0tc2hvdy1vbi1tb2JpbGWTAWh0dHBzOi8vbHd3LmNvbS9zZWN1cmUvcGFnZXMvYWN0aXZhdGVzdWJzY3JpcHRpb24uYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmFic3RyYWN0JTJmMjAyMyUyZjA5MDAwJTJmbmF0dXJhbF9oaXN0b3J5X29mX2FuYWxfdWxjZXJhdGlvbnNfaW4uMjcuYXNweAAiQWN0aXZhdGUgeW91ciBqb3VybmFsIHN1YnNjcmlwdGlvbmQCAQ9kFgJmDxUEGmVqcC1mb290ZXItLWhpZGUtb24tbW9iaWxlkwFodHRwczovL2x3dy5jb20vc2VjdXJlL3BhZ2VzL2FjdGl2YXRlc3Vic2NyaXB0aW9uLmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZhYnN0cmFjdCUyZjIwMjMlMmYwOTAwMCUyZm5hdHVyYWxfaGlzdG9yeV9vZl9hbmFsX3VsY2VyYXRpb25zX2luLjI3LmFzcHgAHUFjdGl2YXRlIEpvdXJuYWwgU3Vic2NyaXB0aW9uZAICD2QWAmYPFQQaZWpwLWZvb3Rlci0taGlkZS1vbi1tb2JpbGU4aHR0cHM6Ly93a2hscnAubXkuc2l0ZS5jb20vTGlwcGluY290dE9ubGluZUhlbHBDZW50ZXIvcy8AFkJyb3dzZSB0aGUgaGVscCBjZW50ZXJkAgMPZBYCZg8VBBplanAtZm9vdGVyLS1zaG93LW9uLW1vYmlsZVlodHRwczovL3draGVhbHRoLmZvcmNlLmNvbS9sd3dvbmxpbmUvcy90b3BpYy8wVE8wVjAwMDAwMVlnTFpXQTAvbHd3LW9ubGluZT90YWJzZXQtZGRiZmU9MgAESGVscGQCBw8WBh8BBSBodHRwczovL3d3dy50ZmFmb3Jtcy5jb20vNDk2NjU3MB4GdGFyZ2V0BQZfYmxhbmsfKgUYU3VibWl0IGEgU2VydmljZSBSZXF1ZXN0ZAIJDxYCHwBoZAILDxYCHwBoZAIPDxQrAAIPFgQfJmcfJwICZGQWBGYPZBYCZg8VAR04MDAtNjM4LTMwMzAgKHdpdGhpbiB0aGUgVVNBKWQCAQ9kFgJmDxUBITMwMS0yMjMtMjMwMCAob3V0c2lkZSBvZiB0aGUgVVNBKWQCEQ8WAh8AZ2QCBw8WAh8sBbEReyJsb2dpbkNvbmZpZ3VyYXRpb24iOnsic2VydmljZVVybCI6Imh0dHBzOi8vc2VydmljZXMuam91cm5hbHMubHd3LmNvbS9JbnRlZ3JhdGlvblNlcnZpY2VzL0FjY291bnRTZXJ2aWNlLnN2Yy9Mb2dpbiIsInJlZ2lzdGVyVXJsIjoiaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9wYWdlcy9yZWdpc3Rlci5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDkwMDAlMmZuYXR1cmFsX2hpc3Rvcnlfb2ZfYW5hbF91bGNlcmF0aW9uc19pbi4yNy5hc3B4IiwiZm9yZ290UGFzc3dvcmRVcmwiOiJodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3BhZ2VzL2ZvcmdvdHBhc3N3b3JkLmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZhYnN0cmFjdCUyZjIwMjMlMmYwOTAwMCUyZm5hdHVyYWxfaGlzdG9yeV9vZl9hbmFsX3VsY2VyYXRpb25zX2luLjI3LmFzcHgiLCJyZWRpcmVjdFVybCI6Imh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvcGFnZXMvbG9naW4uYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmFic3RyYWN0JTJmMjAyMyUyZjA5MDAwJTJmbmF0dXJhbF9oaXN0b3J5X29mX2FuYWxfdWxjZXJhd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1,005)","https://images.journals.lww.com/ajg/Rollover.00000434-202309000-00027.T1.jpeg","https://images.journals.lww.com/ajg/Gallery.00000434-202309000-00027.T1.jpeg","https://journals.lww.com/ajg/_layouts/oaks.journals/ImageView.aspx?k=ajg:2023:09000:00027&i=T1&year=2023&issue=09000&article=00027&type=Abstract","https://images.journals.lww.com/ajg/Original.00000434-202309000-00027.T1.jpeg","/ajg/pages/imagegallery.aspx?year=2023&issue=09000&article=00027", "ajg_2023_09000_00027_T1");images["F1"]=new image("F1","F2","T1","Figure 1.","Cumulative risk of anal ulceration in patients with pediatric-onset Crohn\'s disease.","https://images.journals.lww.com/ajg/Rollover.00000434-202309000-00027.F1.jpeg","https://images.journals.lww.com/ajg/Gallery.00000434-202309000-00027.F1.jpeg","https://journals.lww.com/ajg/_layouts/oaks.journals/ImageView.aspx?k=ajg:2023:09000:00027&i=F1&year=2023&issue=09000&article=00027&type=Abstract","https://images.journals.lww.com/ajg/Original.00000434-202309000-00027.F1.jpeg","/ajg/pages/imagegallery.aspx?year=2023&issue=09000&article=00027", "ajg_2023_09000_00027_F1");images["F2"]=new image("F2","T2","F1","Figure 2.","Cumulative incidence of anal ulceration according to the location of the disease (<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">a</strong>), presence of upper gastrointestinal involvement (<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">b</strong>), and presence of extradigestive manifestations (<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">c</strong>). 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document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Citation(title, journalId, ovidId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Citation'; 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function alerts_ShowUnSubscribeeTOCSuccessPopup() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } $('.js-close').on('click', function() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.hide(); } return false; }); </script> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl"></span> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscribeToEtocPopupState" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState" value="showemail" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenConfirmSubscriptionPageUrl" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl" /> <input type="hidden" 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document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState'); var emailTextBox = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress'); var thanksPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser'); var mainPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain'); var thankYouMessageUnAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage'); var thankYouMessageAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle'); if (!displaySubscriptionType) { displaySubscriptionType = subscriptionType; } if (modelPopupState.value == 'showthanksmessage') { thanksPanel.style.display = "block"; mainPanel.style.display = "none"; thankYouMessageAuthenticated.innerHTML = "Thank you for subscribing to the " + displaySubscriptionType + " for " + journalTitle + "."; } if (modelPopupState.value == 'showemail') { thanksPanel.style.display = "none"; mainPanel.style.display = "block"; thankYouMessageUnAuthenticated.innerHTML = "Thank you for choosing to subscribe to the " + displaySubscriptionType + " for " + journalTitle + "."; } if ($('.etoc-popup') != null) { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').value = journalId; if (modelPopupState.value == 'showemail') emailTextBox.focus(); } } $('.js-close').on('click', function () { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress').value = ""; document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').style.display = "none"; var pageUrl = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl'); var subscribeeTocPopup = $find('subscribeToEtoc'); if (subscribeeTocPopup != null) { subscribeeTocPopup.hide(); document.getElementsByTagName( 'html' )[0].classList.remove('no-scroll'); if (pageUrl.value !== '' && pageUrl.value !== window.location.pathname) window.location = pageUrl.value; } return false; }); </script> <div id="ctl00_ctl51_Header_UserActionTools_eTocTopContainer"> <div id="eTocTop" style="display: none;"> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup('Official journal of the American College of Gastroenterology | ACG','ajg','eTOC', 'eTOC');;" onclick="javascript: alerts_ShowSubscribeeTOCPopup('Official journal of the American College of Gastroenterology | ACG','ajg','eTOC', 'eTOC');"><span id="ctl00_ctl51_Header_UserActionTools_alertLinkControlTop_defaultText" class="hideOnFixed">Subscribe to eTOC</span></a> 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History of Anal Ulcerations in Pediatric-Onset Crohn\'s Disease: Long-Term Follow-Up of a Population-Based Study', '04252023', 'Perrine Mortreux, Ariane Leroyer, Claire Dupont, et al', '118', '9', '\u00A9 2023 by The American College of Gastroenterology', '00000434-202309000-00027', '', false, ''); } </script> <div id="ArticleContainer"> <article id="ej-abstract-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">ARTICLES: PEDIATRICS</div></section><header class="ejp-article-header"><h1 class="ejp-article-title">Natural History of Anal Ulcerations in Pediatric-Onset Crohn's Disease: Long-Term Follow-Up of a Population-Based Study</h1></header><section id="ejp-article-authors"><p id="P7">Mortreux, Perrine MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1,*</sup>; Leroyer, Ariane MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">2,3,*</sup>; Dupont, Claire MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">4</sup>; Ley, Delphine MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">3,5</sup>; Bertrand, Valérie MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">6</sup>; Spyckerelle, Claire MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">7</sup>; Guillon, Nathalie MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">2,3</sup>; Wils, Pauline MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1,3</sup>; Gower-Rousseau, Corinne MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">8</sup>; Savoye, Guillaume MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">9</sup>; Fumery, Mathurin MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">10</sup>; Turck, Dominique MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">3,5</sup>; Siproudhis, Laurent MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">11</sup>; Sarter, Hélène MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">2,3</sup></p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup>Lille University Hospital, Gastroenterology, Lille, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">2</sup>Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">3</sup>Lille University, Inserm, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">4</sup>Department of Pediatrics, Gastroenterology, Caen University Hospital, Caen, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">5</sup>Department of Pediatrics, Lille University Hospital, Lille, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">6</sup>Department of Pediatrics, Le Havre Hospital, Le Havre, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">7</sup>Department of Pediatrics, GHICL, Lille, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">8</sup>Department of Epidemiology, Reims University Hospital, Reims, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">9</sup>Department of Gastroenterology, Rouen University Hospital, Rouen, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">10</sup>Department of Gastroenterology, Amiens University Hospital, Amiens, France;</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">11</sup>Department of Gastroenterology, Rennes University Hospital, Rennes, France.</p> <p id="cor1"><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Correspondence:</strong> Hélène Sarter, MD. E-mail: <span><a href="/cdn-cgi/l/email-protection#dfb2beb6b3abb0e5b7bab3bab1baf1acbeadabbaad9fbcb7adaaf2b3b6b3b3baf1b9ad" onclick="javascript:window.open('mailto:mailto:helene.sarter@chru-lille.fr');return false"><span class="__cf_email__" data-cfemail="4a222f262f242f64392b383e2f380a2922383f67262326262f642c38">[email protected]</span></a></span>.</p> <p id=""><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">SUPPLEMENTARY MATERIAL</strong> accompanies this paper at <span><a href="https://links.lww.com/AJG/C943" onclick="javascript:window.open('https://links.lww.com/AJG/C943');return false">https://links.lww.com/AJG/C943</a></span>.</p> <p id="fn1"><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">*</sup>Perrine Mortreux and Ariane Leroyer contributed equally to this work.</p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">The American Journal of Gastroenterology </span><span id="ej-journal-date-volume-issue-pg"><a href="/ajg/toc/2023/09000">118(9):p 1671-1678, September 2023.</a></span><span> | </span><span class="ej-journal-doi">DOI: </span>10.14309/ajg.0000000000002301</div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-buy" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Buy()" onmouseout="javascript:Tooltip_MouseOut()"><a href="#ContentAccessOptions"><span class="ejp-indicator">Buy</span></a></li> <li id="ej-article-indicators-sam" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_SDC()" onmouseout="javascript:Tooltip_MouseOut()"><span class="ejp-indicator">SDC</span></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.14309/ajg.0000000000002301" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="2023-04-25" data-articlePublicationDateString="April 25, 2023" data-receivedDate="2023-01-19" data-revisionReceivedDate="" data-acceptedDate="2023-04-10" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId="37104674"><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <h3>INTRODUCTION: </h3> <p>Anal ulcerations are frequently observed in Crohn's disease (CD). However, their natural history remains poorly known, especially in pediatric-onset CD.</p> <h3>METHODS: </h3> <p>All patients with a diagnosis of CD before the age of 17 years between 1988 and 2011 within the population-based registry EPIMAD were followed retrospectively until 2013. At diagnosis and during follow-up, the clinical and therapeutic features of perianal disease were recorded. An adjusted time-dependent Cox model was used to evaluate the risk of evolution of anal ulcerations toward suppurative lesions.</p> <h3>RESULTS: </h3> <p>Among the 1,005 included patients (females, 450 [44.8%]; median age at diagnosis 14.4 years [interquartile range 12.0–16.1]), 257 (25.6%) had an anal ulceration at diagnosis. Cumulative incidence of anal ulceration at 5 and 10 years from diagnosis was 38.4% (95% confidence interval [CI] 35.2–41.4) and 44.0% (95% CI 40.5–47.2), respectively. In multivariable analysis, the presence of extraintestinal manifestations (hazard ratio [HR] 1.46, 95% CI 1.19–1.80, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em> = 0.0003) and upper digestive location (HR 1.51, 95% CI 1.23–1.86, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em> < 0.0001) at diagnosis were associated with the occurrence of anal ulceration. Conversely, ileal location (L1) was associated with a lower risk of anal ulceration (L2 vs L1 HR 1.51, 95% CI 1.11–2.06, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em> = 0.0087; L3 vs L1 HR 1.42, 95% CI 1.08–1.85, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em> = 0.0116). The risk of fistulizing perianal CD (pCD) was doubled in patients with a history of anal ulceration (HR 2.00, 95% CI 1.45–2.74, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em> < 0.0001). Among the 352 patients with at least 1 episode of anal ulceration without history of fistulizing pCD, 82 (23.3%) developed fistulizing pCD after a median follow-up of 5.7 years (interquartile range 2.8–10.6). In these patients with anal ulceration, the diagnostic period (pre vs biologic era), exposure to immunosuppressants, and/or anti–tumor necrosis factor did not influence the risk of secondary anoperineal suppuration.</p> <h3>DISCUSSION: </h3> <p>Anal ulceration is frequent in pediatric-onset CD, with nearly half of patients presenting with at least 1 episode after 10 years of evolution. 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}); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","PopupControlID":"ctl00_ctl29_g_05816bca_ab8a_4648_9820_e541e93c2483_ctl00_emailToColleague_pnlEmailToColleague","dynamicServicePath":"/ajg/pages/articleviewer.aspx","id":"emailToColleaguePopupExtender_217635073"}, null, null, $get("ctl00_ctl29_g_05816bca_ab8a_4648_9820_e541e93c2483_ctl00_emailToColleague_hypEmailToColleague")); }); //]]> </script> </form> <span id="DeltaPlaceHolderUtilityContent"> </span> <script type="text/javascript">// <![CDATA[ var g_Workspace = "s4-workspace"; // ]]> </script> <div id="ctl00_ctl64_divAdConfig" data-adconfig="{"adTitle":"Advertisement","slotClass":"ad-slot-container","topBanner":{"sticky":"true","stickyDuration":"5000"},"lazyLoadingEnabled":false,"npiHash":"","pageTargeting":{"ArticleId":"00000434-202309000-00027"}}" data-videoadconfig="{"serverURL":"https://pubads.g.doubleclick.net/gampad/ads","sizes":"320x180|640x360","overlayUnitPath":"/15726702761/Desktop/ajg/Video/overlay","prerollUnitPath":"/15726702761/Desktop/ajg/Video/pre-roll","postrollUnitPath":"/15726702761/Desktop/ajg/Video/post-roll"}" class="js-ad-config"> </div> <div id="ctl00_ctl64_divScripts"><script type="text/plain" async="async" src="https://securepubads.g.doubleclick.net/tag/js/gpt.js" class="optanon-category-C0004"></script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/ads.js?v=05.24.00.023" defer="true"> </script> </div>  <script type="text/javascript"> (function($) { if (false) { $(".top-microbar-container").addClass('top-microbar-container-moved').insertAfter(".advertisement-content_top"); 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