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How Secure Is the Diagnosis of Ulcerative Colitis in Children, Even After Colectomy?
Ian Jones1, Pramila Ramani2, Christine Spray3
1Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham.
Insights
A colectomy for ulcerative colitis (UC) in children may lead to a later diagnosis of Crohn disease (CD). This study found a 24% reclassification rate, higher than previously reported, impacting surgical decisions.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Distinguishing ulcerative colitis (UC) from Crohn disease (CD) can be challenging in pediatric patients, even post-colectomy.
- Colectomy is considered definitive for UC, but misdiagnosis can occur, impacting long-term management.
- Historical reclassification rates of UC to CD post-colectomy range from 3-7%, with recent studies suggesting up to 13% in children.
Purpose of the Study:
- To assess the rate of reclassification from ulcerative colitis (UC) to Crohn disease (CD) in children following colectomy.
- To evaluate the implications of potential reclassification on pre-operative counseling and surgical decision-making.
Main Methods:
- Retrospective review of pediatric patients undergoing colectomy for UC between 2003 and 2014 at a single tertiary referral center.
- Analysis of colectomy specimen histology and long-term follow-up for subsequent CD diagnosis.
Main Results:
- Of 190 children diagnosed with UC, 29 underwent colectomy.
- No cases were reclassified based on initial colectomy histology.
- Seven of 29 patients (24%) were subsequently diagnosed with Crohn disease, a significantly higher rate than previously reported (P=.003).
Conclusions:
- Later manifestation of Crohn disease after an initial ulcerative colitis diagnosis is more common in children than previously recognized (24%).
- Pediatric diagnoses of UC should be considered provisional.
- The potential for later CD diagnosis must be considered in surgical planning, including colectomy and J-pouch formation.
Objectives:
We reviewed all children who have undergone a colectomy for ulcerative colitis (UC) in our tertiary referral centre in a 12-year period to assess the rate of reclassification as Crohn disease (CD). In contrast to CD, a colectomy is considered to be definitive treatment for patients with UC. Distinguishing between the 2 can be challenging when disease is manifest only within the colon-even histological examination of a colectomy specimen may be inconclusive. Historically, the recognised "rediagnosis" rate (post-colectomy) was reported at approximately 3% to 7%. A recent study suggested that a higher rate of 13% should be expected in children. This has implications in terms of pre-operative counselling and surgical decision making.
Methods:
A retrospective case-note review of all patients who underwent a colectomy for UC between 2003 and 2014 in a single paediatric tertiary referral centre was performed.
Results:
Of the 570 children diagnosed with inflammatory bowel disease in this period, 190 were diagnosed as UC. Of these 190 cases, 29 underwent a colectomy. None of these was re-classified following histological examination of the colectomy sample. Seven out of the 29 patients (24%) were subsequently diagnosed with CD (median follow-up 7.6 years). This is significantly higher than previously reported rates (P = 0.003).
Conclusions:
Our data suggest that later manifestation of CD is more common than previously thought (24%). Therefore, a diagnosis of UC in children should be regarded as provisional and a potential later diagnosis of CD taken into account when considering colectomy and J-pouch formation.
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