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Ulcerative proctitis is a frequent location of paediatric-onset UC and not a minor disease: a population-based study
A Hochart1, C Gower-Rousseau2,3, H Sarter2,3
1Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Lille University and Hospital, France et Univ. Lille CHU Lille, Lille, France.
Insights
Paediatric ulcerative proctitis (UP) is common in ulcerative colitis (UC) and not a minor condition. Risks for colonic extension and colectomy were similar to more extensive UC, but immunosuppressant use was lower.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Ulcerative proctitis (UP) is a subtype of ulcerative colitis (UC) primarily affecting the rectum.
- The natural history and disease course of pediatric-onset UP are not well-characterized.
- Understanding UP in children is crucial for appropriate management and predicting long-term outcomes.
Purpose of the Study:
- To describe the phenotype and disease course of incident UP in a population-based cohort of pediatric-onset UC.
- To compare the risks of colonic extension, medical therapy, and colectomy in UP versus more extensive UC in children.
- To identify potential risk factors for disease progression in pediatric UP.
Main Methods:
- A population-based registry was used to identify patients diagnosed with UC before age 17 between 1988 and 2004.
- Patients were followed for at least 2 years, with UC location classified using the Paris classification.
- Kaplan-Meier methods assessed cumulative risks for immunosuppressants, anti-TNF-α therapy, colonic extension, and colectomy; Cox models evaluated risk factors.
Main Results:
- Of 158 pediatric UC patients, 25% had UP (E1) at diagnosis. At maximal follow-up (median 11.4 years), 49% of UP patients experienced colonic extension.
- Cumulative risks for colonic extension in UP were 10% at 1 year, 45% at 5 years, and 52% at 10 years.
- Risks for colonic extension, anti-TNF-α therapy, and colectomy were similar between UP (E1) and more extensive UC (E2-E4) groups, but immunosuppressant use was lower in UP.
Conclusions:
- Ulcerative proctitis is a frequent diagnosis in pediatric ulcerative colitis and should not be underestimated.
- The risk of disease progression (colonic extension) and need for surgery (colectomy) in pediatric UP are comparable to more extensive UC.
- While immunosuppressant therapy is less frequently required for UP, its potential for progression warrants close monitoring.
Objective:
Natural history of paediatric-onset ulcerative proctitis (UP) is poorly described. Our aim was to describe the phenotype and disease course of incident UP in a population-based study of paediatric-onset UC.
Patients And Methods:
All patients with UC diagnosed <17 years from 1988 to 2004, and followed during >2 years have been extracted from a population-based registry. UC location was defined according to the Paris classification. Cumulative risks for use of immunosuppressants (IS), anti-tumour necrosis factor alpha (TNF-α) therapy, colonic extension and colectomy were described using Kaplan-Meier method. Risk factors for colonic extension were assessed using Cox proportional hazards models.
Results:
158 patients with paediatric-onset UC (91 females) with a median age at diagnosis of 14.5 years (Q1: 11.4-Q3: 16.1) have been identified and followed during a median of 11.4 years (8.2-15.8). Among them, 25% had UP (E1) at diagnosis and 49% of them presented a colonic extension at maximal follow-up. In these children, the cumulative risk for colonic extension was 10% at 1 year, 45% at 5 years and 52% at 10 years. No parameter at diagnosis was associated with colonic extension in the UP (E1 group). IS use was significantly lower in patients with UP than in those with E2, E3 or E4 location (p=0.049). For the UP cohort, the cumulative risk for colectomy was 3% at 1 year, 10% at 5 years, 13% at 10 years and 13% at 15 years. Risks for colonic extension, treatment with anti-TNF-α and colectomy did not differ between the E1 group and the E2-E3-E4 group.
Conclusions:
UP is frequent in paediatric-onset UC and should not be considered as a minor disease. Compared with more extensive UC locations, risks for colonic extension, anti-TNF-α therapy and colectomy were similar in UP, whereas the risk for use of IM was lower.
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