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Poor catch-up growth after proctocolectomy in pediatric patients with ulcerative colitis receiving prolonged steroid

Keiichi Uchida1, Toshimitsu Araki, Mikihiro Inoue

  • 1Department of Gastrointestinal and Pediatric Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. ucchie@clin.medic.mie-u.ac.jp

Pediatric Surgery International
|February 26, 2010
PubMed

Insights

Prolonged steroid use in pediatric ulcerative colitis (UC) patients undergoing proctocolectomy with ileal J-pouch anal anastomosis (IPAA) can impair growth. Early colectomy may help patients achieve normal growth and become steroid-free.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Endocrinology

Background:

  • Pediatric ulcerative colitis (UC) management often involves prolonged steroid therapy.
  • Surgical intervention like proctocolectomy with ileal J-pouch anal anastomosis (IPAA) is considered for refractory UC.
  • The impact of long-term steroid use on growth following IPAA in pediatric UC patients is not fully understood.

Purpose of the Study:

  • To review complications and growth outcomes after IPAA in pediatric UC patients exposed to prolonged steroid therapy.
  • To assess the relationship between steroid dosage and growth in these patients.
  • To evaluate the effect of early colectomy on steroid dependency and growth recovery.

Main Methods:

  • Retrospective review of medical records for 16 pediatric UC patients (<15 years) who underwent IPAA between 2000 and 2009 with >1 year follow-up.
  • Analysis of preoperative steroid (prednisolone - PSL) dosage and steroid-related complications (SRC).
  • Comparison of growth (height) between younger (< or =11 years) and older (>11 years) patients, and between high-dose (>10,000 mg) and low-dose (<=10,000 mg) PSL groups over 5 years.

Main Results:

  • The mean total preoperative prednisolone (PSL) dose was 9,829 mg.
  • Higher preoperative PSL doses significantly correlated with major steroid-related complications (SRC).
  • Older pediatric patients (>11 years) and those receiving high-dose PSL (>10,000 mg) exhibited slower growth and did not reach standard height levels within 5 years post-colectomy.

Conclusions:

  • Prolonged preoperative high-dose steroid therapy may hinder growth recovery in pediatric UC patients undergoing IPAA.
  • Early colectomy in steroid-dependent pediatric UC patients can facilitate steroid cessation and promote normal growth.
  • Optimizing steroid management and considering early surgical intervention are crucial for improving long-term outcomes in pediatric UC.
Abstract

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