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Difference between early onset and late-onset pediatric ulcerative colitis
Ryusuke Nambu1, Shin-Ichiro Hagiwara2, Mitsuru Kubota2
1Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan. nambee1231@gmail.com.
Insights
Early onset pediatric ulcerative colitis (EO-UC) presents with more pancolitis and extra-intestinal issues, often with a longer diagnostic delay compared to late onset UC. Diagnosis and treatment can be more challenging for EO-UC patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Early onset ulcerative colitis (EO-UC) differs from late onset UC (LO-UC) due to genetic factors.
- Limited data exists on EO-UC clinical features in Asian populations.
Purpose of the Study:
- To compare the clinical presentation and disease course of EO-UC (0-7 years) with LO-UC (8-15 years).
- To identify differences in diagnosis, disease extent, and complications between EO-UC and LO-UC.
Main Methods:
- Retrospective analysis of 63 pediatric UC patients diagnosed between 2004-2014 in Japan.
- Comparison of EO-UC (n=10) and LO-UC (n=53) groups based on clinical data.
Main Results:
- EO-UC patients showed a higher incidence of pancolitis (100% vs 70%) compared to LO-UC.
- Diagnostic delay was significantly longer in EO-UC (9.0 months vs 2.6 months).
- Extra-intestinal complications were more prevalent in EO-UC (50% vs 11%) at diagnosis.
Conclusions:
- EO-UC is associated with pancolitis, delayed diagnosis, and increased extra-intestinal manifestations.
- Diagnosis and management of EO-UC may present greater challenges than LO-UC.
Background:
Early onset pediatric ulcerative colitis (EO-UC) is distinguished from late-onset pediatric ulcerative colitis (LO-UC) by the effects of genetic predisposition, but there have been few reports on the clinical features of EO-UC in Asia.
Methods:
To describe and compare the presentation and disease course of EO-UC (age range, 0-7 years) with those of LO-UC (age range, 8-15 years), we retrospectively analyzed 63 children with UC who had been diagnosed between January 2004 and March 2014 at Saitama Children's Medical Center in Japan.
Results:
Ten patients (16%) had EO-UC, and 53 (84%) had LO-UC. All patients in the EO-UC group and 70% in the LO-UC group had pancolitis (P = 0.05). The period from onset to diagnosis was 9.0 ± 14.1 months for EO-UC and 2.6 ± 3.5 months for LO-UC (P < 0.01). The prevalence of extra-intestinal complications at diagnosis was significantly higher for EO-UC than for LO-UC (50% vs 11%, respectively; P < 0.01). There were no significant differences in the use of corticosteroids, immunomodulators, immunosuppressants, or surgical risk between the groups but, in the EO-UC group, only one patient was treated with cytapheresis and none was treated with anti-tumor necrosis factor (TNF-α) antibodies.
Conclusions:
The EO-UC group had a higher incidence of pancolitis, longer diagnostic delay, and more extra-intestinal manifestations than the LO-UC group. Diagnosis and treatment may therefore be slightly more difficult for EO-UC than for LO-UC.
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