Paediatric Ulcerative Colitis Is a Fibrotic Disease and Is Linked with Chronicity of Inflammation

Abstract

Background & Aims Intestinal fibrosis has recently been characterized in adult ulcerative colitis and may affect motility, diarrhea, and the symptom of urgency. We aimed to characterize the presence of fibrosis in pediatric patients with ulcerative colitis, and its link to severity and chronicity of mucosal inflammation, as well as clinical factors of severity. Methods We performed a single center cross-sectional study in ulcerative colitis children ages 1-18 years undergoing colectomy or proctocolectomy. Tissue cross-sections were derived from proximal, mid and distal colon and rectum, and inflammation and fibrosis were graded based on previously developed scores. Clinical data were collected prospectively. Results 205 intestinal sections of 62 patients were evaluated. Median age at diagnosis was 13 years, 100% had extensive colitis, and all resections were done for refractory disease. The presence, chronicity and degree of inflammation were linked with the presence of fibrosis. Thickness of the muscularis mucosa was also linked with presence and chronicity of inflammation. The overall submucosal fibrosis burden was associated with prior anti-tumor necrosis factor use. Conclusion Pediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlates with the presence, chronicity and degree of mucosal inflammation. Fibrosis should be recognized as a complication of pediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease.

Ulcerative colitis, a transmural disease requiring an accurate IUS assessment in the current treat‐to‐target era

“…Yet, as our understanding of involvement beyond the mucosa in UC evolves, the importance of achieving transmural healing in UC may become clearer. 9 The current study by Allocca et al sheds light on this, 3 and provides the first evidence of the utility of a validated transmural ultrasound score to predict disease progression in UC. The key findings of this study are the ability of a MUC score >6.2 to predict a negative disease course (Hazard Ratio [HR] 3.87, 95% confidence interval [CI] 2.25-6.64).…”

“…Achievement of deep remission using this treat‐to‐target approach in Crohn's disease has shown to prevent disease progression in a post‐hoc analysis of the CALM trial, 8 but this has not yet been shown prospectively in UC. Yet, as our understanding of involvement beyond the mucosa in UC evolves, the importance of achieving transmural healing in UC may become clearer 9 . The current study by Allocca et al.…”

Bioactive Components and Potential Mechanism Prediction of Kui Jie Kang against Ulcerative Colitis via Systematic Pharmacology and UPLC-QE-MS Analysis

“…Inflammatory bowel disease is a chronic, recurrent, and autoimmune disease that primarily occurs in the colon and bowel and includes Crohn's disease and ulcerative colitis (UC) [ 1 , 2 ]. UC is a common diffuse, nonspecific, and recurrent inflammatory disease of the rectum and colon mucosa and submucosa with high rates of relapse and canceration [ 3 ]. The incidence of UC has recently increased [ 4 ] with over 6.8 million cases having been reported worldwide [ 5 ].…”

“…The incidence of UC has recently increased [ 4 ] with over 6.8 million cases having been reported worldwide [ 5 ]. Moreover, the age of onset tends to be 20–40 years old and can also be seen in children or the elderly [ 3 ]. It can be characterized by periods of remission followed by repeated flare-ups [ 3 ].…”

“…Moreover, the age of onset tends to be 20–40 years old and can also be seen in children or the elderly [ 3 ]. It can be characterized by periods of remission followed by repeated flare-ups [ 3 ]. Its symptoms include belly aches, bloody diarrhea, proctorrhagia, and fatigue in addition to symptoms outside of the intestine, such as peripheral arthritis, noninfective conjunctivitis, and weight loss, which affect the quality of life and economic status of patients [ 6 ].…”