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The natural history of pediatric ulcerative colitis: a population-based cohort study
Corinne Gower-Rousseau1, Luc Dauchet, Gwénola Vernier-Massouille
1Registre des Maladies inflammatoires chroniques de l'Intestin du Nord Ouest de la France Pôle de Santé Publique CHRU, EA2694-Université de Lille 2, France.
Insights
Pediatric ulcerative colitis (UC) often presents with extensive disease and progresses, with 20% of children undergoing colectomy within 5 years. Disease extension and extra-intestinal manifestations significantly increase colectomy risk.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- The natural history and long-term outcomes of pediatric ulcerative colitis (UC) are not well-established.
- Understanding disease progression is crucial for timely intervention in children with UC.
Purpose of the Study:
- To describe the natural history of ulcerative colitis in a pediatric cohort.
- To identify risk factors for disease extension and colectomy in children diagnosed with UC.
Main Methods:
- A geographically derived incidence cohort of 113 pediatric UC patients (age 0-17) diagnosed between 1988-2002 was analyzed.
- Kaplan-Meier method estimated colectomy risk; logistic and Cox proportional hazards models assessed risk factors for disease extension and colectomy, respectively.
- Follow-up data for at least 2 years was available for all patients.
Main Results:
- At diagnosis, 49% of pediatric UC patients experienced disease extension.
- Delayed diagnosis (>6 months) and family history of IBD increased disease extension risk (OR 5.0 and 11.8, respectively).
- Cumulative colectomy rates were 8% (1 year), 15% (3 years), and 20% (5 years); extra-intestinal manifestations (EIMS) at diagnosis (HR=3.5) and disease extension in initially limited disease (HR=13.3) were associated with higher colectomy risk.
Conclusions:
- Pediatric UC frequently presents with widespread disease and high rates of extension.
- Colectomy is required in 20% of children within 5 years, influenced by disease extension and EIMS at diagnosis.
- Early diagnosis and management are critical to potentially mitigate disease progression and colectomy rates in pediatric UC.
Objectives:
The natural history of ulcerative colitis (UC) has been poorly described in children.
Methods:
In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 113 UC patients (age 0-17 years at diagnosis) with a follow-up of at least 2 years. The cumulative risk of colectomy was estimated by the Kaplan-Meier method. Risk factors for disease extension were assessed with logistic regression models, and risk factors for colectomy with Cox hazards proportional models.
Results:
Median follow-up time was 77 months (46-125). At diagnosis, 28% of patients had proctitis, 35% left-sided colitis, and 37% extensive colitis. Disease course was characterized by disease extension in 49% of patients. A delay in diagnosis of more than 6 months and a family history of inflammatory bowel disease were associated with an increased risk of disease extension, with odds ratios of 5.0 (1.2-21.5) and 11.8 (1.3-111.3), respectively. The cumulative rate of colectomy was 8% at 1 year, 15% at 3 years, and 20% at 5 years. The presence of extra-intestinal manifestations (EIMS) at diagnosis was associated with an increased risk of colectomy (hazard ratio (HR)=3.5 (1.2-10.5)). Among the patients with limited disease at diagnosis, the risk of colectomy was higher in those who experienced disease extension than in those who did not (HR=13.3 1.7-101.7).
Conclusions:
Pediatric UC was characterized by widespread localization at diagnosis and a high rate of disease extension. Twenty percent of children had their colon removed after 5 years. The colectomy rate was influenced by disease extension and was associated with the presence of EIMS at diagnosis.
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