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Review article: the natural history of paediatric-onset ulcerative colitis in population-based studies
M Fumery1, D Duricova2,3, C Gower-Rousseau3,4,5
1Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France.
Insights
Pediatric ulcerative colitis (UC) often involves extensive disease and requires significant medical intervention, including surgery for some. Understanding its natural history is key to improving care for children with UC.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Chronic Disease Epidemiology
Background:
- Knowledge of chronic disease natural history is vital for patient management and treatment evaluation.
- Disabling chronic diseases require comprehensive understanding for effective patient support.
- Predictors for disease progression and patient information are essential.
Purpose of the Study:
- To review population-based studies on the natural history of ulcerative colitis (UC) in children.
- To summarize current knowledge regarding pediatric-onset UC outcomes.
- To identify trends in disease progression and treatment in young UC patients.
Main Methods:
- Systematic search of MEDLINE (PubMed) and conference abstracts.
- Inclusion of population-based studies assessing long-term outcomes.
- Focus on ulcerative colitis diagnosed in individuals under 17 years old.
Main Results:
- 26 studies reviewed, most pediatric UC patients experienced disease extension, with two-thirds having pancolitis.
- Half of patients had extra-intestinal manifestations; 5-10% had primary sclerosing cholangitis.
- Two-thirds needed corticosteroids, 25% were steroid-dependent; colectomy occurred in 20% within 10 years.
Conclusions:
- Pediatric-onset UC is marked by high disease extension rates and significant surgical intervention.
- Approximately 20% of pediatric UC patients undergo colectomy within a decade.
- Further population-based research is needed to assess novel immunosuppressant and biologic therapies.
Background:
A better knowledge of the natural history of disabling chronic diseases is essential to improve patient management, evaluate the impact of treatment strategies and provide predictors for disabling disease and comprehensive information for patients.
Aim:
To summarise our current knowledge issued from population-based studies of the natural history of ulcerative colitis (UC) in children.
Methods:
We searched MEDLINE (source PubMed) and international conference abstracts, and included all population-based studies that evaluated long-term outcome of paediatric-onset (<17 years at diagnosis) UC.
Results:
A total of 26 population-based studies were considered in this review from the total of 61 articles or abstracts screened. Most patients presented disease extension and about two-thirds of patients had pancolitis at the end of follow-up. One-half of patients experienced extra-intestinal manifestations and primary sclerosing cholangitis was observed in 5-10% of patients. Overall, patients did not appear to have any significant growth retardation or delayed puberty. About two-thirds of patients required corticosteroid therapy and up to 25% were steroid dependent. An increased use of thiopurines was observed and the most recent data indicate that up to one-half of patients were exposed to thiopurines and 10-30% were exposed to anti-tumour necrosis factor. One-half of patients required hospitalisations and 20% of patients required colectomy after a follow-up of 10 years.
Conclusions:
Paediatric-onset UC is characterised by a high rate of disease extension. About 20% of patients had been operated at 10-year follow-up. New population-based studies are needed to evaluate the impact of new treatment strategies comprising immunosuppressants and biologics.
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