Abdominal X-ray in Pediatric Acute Severe Colitis and Radiographic Predictors of Response to Intravenous Steroids
Alina Livshits1, Drora Fisher, Irith Hadas
1*Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center †Hebrew University of Jerusalem, Jerusalem, Israel ‡Alder Hey Children's NHS Foundation Trust, Liverpool, UK §Children's Hospital of Eastern Ontario IBD Centre ||Department of Pediatrics, University of Ottawa, Ottawa, Canada ¶Connecticut Children's Medical Center, Hartford, CT #Nationwide Children's Hospital, Ohio State University, Columbus **SickKids Hospital, University of Toronto, Toronto, Canada.
Insights
Abdominal X-rays (AXR) can predict treatment response in children with acute severe colitis (ASC). Findings like ulcerations and megacolon on AXR may indicate a need for aggressive treatment in pediatric ASC patients.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Inflammatory Bowel Disease
Background:
- Abdominal X-ray (AXR) aids in identifying complications in acute severe colitis (ASC).
- AXR may help select high-risk pediatric patients for early, aggressive treatment.
- This study describes AXR findings in pediatric ASC and identifies predictors of treatment response.
Purpose of the Study:
- To describe AXR findings in pediatric acute severe colitis (ASC).
- To explore radiological predictors of response to intravenous corticosteroid (IVCS) therapy in children with ASC.
Main Methods:
- Retrospective cohort study of 56 children with ASC.
- AXR from IVCS responders and non-responders were analyzed by blinded radiologists.
- Comparison of AXR findings between treatment responders and non-responders.
Main Results:
- Mucosal ulcerations and megacolon on AXR were associated with nonresponse to IVCS.
- Higher day-3 Pediatric Ulcerative Colitis Activity Index (PUCAI) scores were observed in non-responders.
- Transverse colon diameter did not significantly differ between responders and non-responders.
Conclusions:
- AXR findings of mucosal ulcerations and megacolon can aid in risk stratification for pediatric ASC.
- These AXR findings, along with clinical scores and biomarkers, may guide decisions for early aggressive treatment in ASC.
- Radiological assessment can complement existing criteria for managing pediatric ASC.
Background:
Abdominal x-ray (AXR) can identify complications in acute severe colitis (ASC) and may assist in selecting high-risk children for early aggressive treatment. We aimed to describe AXR findings in pediatric ASC and to explore radiological predictors of response to intravenous corticosteroid (IVCS) therapy.
Methods:
A total of 56 children with ASC were included in a multicenter, retrospective 1-year cohort study (41% boys, mean age 12.1 ± 4.2). Radiographs of responders to IVCS and those requiring second-line salvage therapy by discharge were analyzed independently by 2 blinded radiologists.
Results:
A total of 33 responders to IVCS were compared with 23 nonresponders. The day-3 Pediatric Ulcerative Colitis Activity Index (PUCAI) score was significantly higher in nonresponders (63 ± 16 vs 46 ± 21, P = 0.001). The mean transverse colon luminal diameter was 30 ± 16 mm in responders and 38 ± 16 mm in nonresponders (P = 0.94). The upper range of transverse colonic diameter in children <12 years was ∼40 mm, whereas in older children it was 60 mm as accepted in adults. Ulcerations and megacolon seen on AXR were associated with nonresponse to IVCS (P = 0.006 and 0.064, respectively).
Conclusions:
The presence of mucosal ulcerations and megacolon on AXR could be considered in the risk stratification of children with ASC for early aggressive treatment, together with the previously known day-3 and day-5 Pediatric Ulcerative Colitis Activity Index scores, albumin, and C-reactive protein.
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