Improved Medical Treatment and Surgical Surveillance of Children and Adolescents with Ulcerative Colitis in the United Kingdom

Auth, Marcus K.H.; Bunn, Su; Protheroe, A.; Williams, Linda; Fell, John; Muhammed, Rafeeq; Croft, Nicholas M.; Beattie, R Mark; Willmott, Anne; Spray, Christine; Vadamalayan, Babu; Rodrigues, Astor; Puntis, John; Pigott, Anna; Wilson, David C.; Mitton, Sally G.; Furman, M; Charlton, Charlie; Chong, Sonny K. F.; leads, Bspghan Ibd site; Russell, Richard K.

doi:10.1093/ibd/izy042

Cited by 3 publications

(2 citation statements)

References 28 publications

(25 reference statements)

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“…We believe similar results would likely be generated if a freely accessible online steroid assessment tool for paediatrics was made available to other PIBD teams. Similar methodology has been shown to be effective for comparison of data between PIBD centres for biologics and UC care through multiple rounds of the UK IBD audit (16,17). The definition used for steroid dependency within both the original adult study and this paediatric study was limited in that it failed to capture patients who remained on a low dose of steroid for an extended period of time, who would generally be considered steroid-dependent against the standard of steroid-free remission at the centre of PIBD care.…”

Section: Discussionmentioning

confidence: 99%

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Using a Steroid‐sparing Tool in Paediatric Inflammatory Bowel Disease to Evaluate Steroid Use and Dependency

Harris

Sim

Sutton

et al. 2019

J. pediatr. gastroenterol. nutr.

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Objectives: The aim of the study was to evaluate the use of steroids within the paediatric inflammatory bowel disease (PIBD) population at a tertiary paediatric centre over a year; to identify cases of steroid dependency; and assess factors associated with steroid excess. Methods: The prevalent PIBD population (May 1, 2017–April 30, 2018) were reviewed. Data were collected retrospectively from patient records and entered into an online steroid assessment tool (modified for paediatrics). Results: A total of 229 patients (181 Crohn disease, 31 ulcerative colitis [UC], and 17 inflammatory bowel disease–unclassified) were included. Of the 229 patients 38 (16.6%) received oral steroids; 12 of 38 (31.6%) receiving >3-month course. Eleven of 38 (28.9%) received >1 steroid course (maximum 2). Of the 229 patients 37 (16.2%) had exclusive enteral nutrition, with 26 of 37 (11.4% total cohort) avoiding steroid use during the study period. Quiescent disease activity had a negative correlation with steroid use (11/127 [8.7%] vs 27/102 [26.5%] P < 0.01), and steroid dependency (3/127 [2.4%] vs 12/102 [11.8%] P < 0.01). Patients with UC were more likely to be steroid dependent (5/31 [16.1%] UC vs 10/198 [5.1%]; P = 0.02); as were network-managed patients (8/11 [72.7%] vs 7/27 [25.9%]; P = 0.01). Fourteen of 15 (93.3%) of steroid-dependent patients had active steroid sparing strategies in place (eg, commencement, switching, or optimization of therapies). Conclusions: We have described rates of steroid use and dependency within our PIBD population. Exclusive enteral nutrition served as a steroid sparing tool in 11.4% of the total cohort. Replication of this study in other paediatric centres would allow comparative analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using a Steroid‐sparing Tool in Paediatric Inflammatory Bowel Disease to Evaluate Steroid Use and Dependency

Harris

Sim

Sutton

et al. 2019

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

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Severity of complications following restorative proctocolectomy in children is related to staging not diagnosis

O’Connor

Sugarman²,

Patel³

et al. 2020

Journal of Pediatric Surgery

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Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis— A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN

Krauthammer

Tzivinikos

Assa

et al. 2019

Journal of Crohn's and Colitis

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Background and Aim Acute severe colitis [ASC] is associated with significant morbidity in paediatric patients with ulcerative colitis [UC]. Most outcome studies in ASC since tumour necrosis factor alpha [TNFα] antagonists became available have focused on the first year after admission. The aim of this study was to characterise the longer-term outcomes of paediatric patients admitted with ASC. Methods This retrospective study was conducted in 25 centres across Europe and North America. Data on patients with UC aged <18 years, admitted with ASC (defined as paediatric ulcerative colitis activity index [PUCAI] score ≥65) between 2009 and 2011, were collected at discharge and 1, 3 and 5 years after admission. The primary outcome was colectomy-free rates at each time point. Results Of the 141 patients admitted with ASC, 137 [97.1%] were treated with intravenous corticosteroids. Thirty-one [22.6%] patients were escalated to second-line therapy, mainly to infliximab. Sixteen patients [11.3%] underwent colectomy before discharge. Long-term follow-up showed colectomy-free rates were 71.3%, 66.4% and 63.6% at 1, 3 and 5 years after initial ASC admission, respectively, and were similar across different age groups. Sub-analysis of colectomy rates in patients with new-onset disease [42.5% of the cohort] yielded similar results. In a multivariate analysis, use of oral steroids in the 3 months before admission, erythrocyte sedimentation rate >70 mm/h, and albumin <2.5 g/dL, were significantly associated with 5-year colectomy risk. Conclusions High colectomy rates were demonstrated in paediatric UC patients admitted with ASC. Additional studies are required to determine whether intensification of anti-TNFα treatment, close therapeutic drug monitoring, and use of new drugs alter this outcome.

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Improved Medical Treatment and Surgical Surveillance of Children and Adolescents with Ulcerative Colitis in the United Kingdom

Cited by 3 publications

References 28 publications

Using a Steroid‐sparing Tool in Paediatric Inflammatory Bowel Disease to Evaluate Steroid Use and Dependency

Using a Steroid‐sparing Tool in Paediatric Inflammatory Bowel Disease to Evaluate Steroid Use and Dependency

Severity of complications following restorative proctocolectomy in children is related to staging not diagnosis

Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis— A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN

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