The natural history of ulcerative colitis in a pediatric population: a follow-up population- based cohort study

Abstract

BackgroundThe natural history of ulcerative colitis (UC) has been poorly studied in children.MethodsWe performed a retrospective study in children diagnosed with UC with a follow-up. The diagnosis of UC was based on clinical, radiologic, endoscopic, and histologic examinations. We estimated the occurrence of colectomy, proctitis, and extraintestinal manifestations (EIMs) at the onset of the diagnosis and at the end of the study period.ResultsWe identified 115 UC patients between 1986 and 2003 with a mean age at diagnosis of 10.6 ± 5.1 years. The cumulative rate of colectomy was 4.1% at 1 year, and 16% at 10 years. EIMs were experienced by 20% of the children; 48% had arthritis, 35% had sclerosing cholangitis, and 17% had aphthous stomatitis. Proctitis was noted in 29 patients and it was not associated with an increased risk of colectomy (relative risk = 1.4; 95% CI = 0.7–4.5), and girls were twice more likely to develop proctitis. The pathologic reading for disease extensions was recorded for all children at entry and only 62 children had pathological results at maximum follow-up. At entry, 25% of the children only had ulcerative proctitis (E1) localization, 40% had left-sided UC (E2), and 35% had extensive UC (E3). Among the patients with E1 localization, 20% had progressed to E2 and 80% had progressed to E3; among the patients with E2 localization, 40% had progressed to E3. Age, gender, and EIMs at time of diagnosis were not associated with extension of disease at maximal follow-up. The Z score of body mass index (BMI) of children was significantly higher at the end of the study. At diagnosis, 85% of patients received 5-aminosalicyclic acid, 60% received steroids, and 11% received an immunomodulator. The majority of patients were still using systemic steroids at and after 5 years from their entry date. Only 32 of the 91 children on steroids did not receive an immunomodulator.ConclusionPediatric UC is associated with high rates of EIMs and colectomy that are not dependent on age, gender, or race, but is associated with a high rate of proctitis among girls. Understanding the clinical course of UC can optimize therapeutic interventions.

Ulcerative proctitis is a frequent location of paediatric-onset UC and not a minor disease: a population-based study

“…The proportion of children with UC presenting with UP at diagnosis in our study (25%) is consistent with another population-based study reporting also 25% of UP,3 a geographically derived incidence cohort from Denmark reporting the same rate of 25% of UP (18) and from a study through a tertiary paediatric gastroenterology centre reporting a rate of 29% 11. The frequency of UP was much lower in other paediatric cohorts performed in gastroenterological centres with, respectively, 10% and 4% 12 18.…”

“…At diagnosis, the frequency of UP varies widely among studies, and ranges from 4% to 29% in the paediatric population 3 5 7 11–17. The proportion of children with UC presenting with UP at diagnosis in our study (25%) is consistent with another population-based study reporting also 25% of UP,3 a geographically derived incidence cohort from Denmark reporting the same rate of 25% of UP (18) and from a study through a tertiary paediatric gastroenterology centre reporting a rate of 29% 11.…”

The impact of anti‐TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis—a nationwide study from 1995 to 2015

“…Compared to our former publication in this area, we here (a) report an updated analytic approach by including the use of medication as time‐varying covariates in the results for colectomies, (b) include data for a prolonged study period of nationwide paediatric and adolescent patients with UC and (c) examine whether use of corticosteroids is really ceased after introduction of anti‐TNFα therapy. The 5‐year proportion of colectomies in paediatric and adolescent patients with UC have varied both before and after the introduction of anti‐TNFα, ranging from 6% to 20% . Gower‐Rousseau et al reported a 5‐year colectomy proportion of 20% after the diagnosis in a French paediatric cohort of patients with UC in the period 1988‐2002.…”

“…Gower‐Rousseau et al reported a 5‐year colectomy proportion of 20% after the diagnosis in a French paediatric cohort of patients with UC in the period 1988‐2002. Malaty et al reported an approximated colectomy proportion of 14% within a 5‐year period in a US single‐centre paediatric cohort study before the era of anti‐TNFα. A previous Danish study found a 1‐year surgery proportion of 2.4% based on 62 paediatric patients less than 15 years of age in the period 1998‐2009 .…”

“…The incidence of paediatric and adolescent ulcerative colitis (UC) is increasing in several countries. In Denmark, the latest incidences were reported as 7.2 per 100 000 person years for girls and 6.2 per 100 000 person years for boys aged 0‐17 years, and similar increases have been observed in other Nordic countries and in the western world . The treatment is challenging in young patients with UC as they often show a more severe disease presentation and disease course compared to adult patients …”