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Long-term outcomes for children with very early-onset colitis: Implications for surgical management
Kristy L Rialon1, Eileen Crowley2, Natashia M Seemann3
1Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
For children with very early-onset colitis, approximately 25% initially diagnosed with ulcerative colitis (UC) or inflammatory bowel disease unclassified (IBD-U) are later reclassified as Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Surgical Reconstruction Outcomes
Background:
- Very early-onset colitis (VEOC) diagnosis in children under 10 presents management challenges.
- The optimal timing for J-pouch surgery after colectomy in VEOC is debated due to potential misdiagnosis of Crohn's disease (CD).
Purpose of the Study:
- To determine the long-term incidence of Crohn's disease (CD) in children with VEOC.
- To identify clinical predictors for CD risk in this pediatric population.
Main Methods:
- Retrospective review of children diagnosed with noninfectious colitis before age 10.
- Inclusion criteria: subtotal colectomy and ileostomy between 2000 and 2015.
- Analysis of diagnostic reclassifications over time, particularly to Crohn's disease (CD).
Main Results:
- Twenty-five children met the study criteria; median age at presentation was 5.4 years.
- Initial diagnoses included CD (16%), ulcerative colitis (UC) (56%), and IBD unclassified (IBD-U) (28%).
- Five patients (20%) initially diagnosed with UC or IBD-U were later reclassified to CD by a median age of 13.4 years, with no initial CD indicators.
Conclusions:
- A significant proportion (approximately 25%) of children with VEOC initially diagnosed as UC or IBD-U may develop Crohn's disease (CD) later.
- J-pouch reconstruction should be deferred until adolescence in children with VEOC to allow for accurate diagnosis.
Purpose:
The timing of J-pouch surgery following colectomy for children with very early-onset colitis is controversial, with some advocating early reconstruction and others delaying reconstruction because of fear that the colitis may be owing to Crohn's disease (CD). We sought to determine the long-term incidence of CD in this population and whether there may be clinical features that predict the risk of CD.
Methods:
Children with noninfectious colitis diagnosed prior to age 10, who underwent subtotal colectomy and ileostomy from 2000 to 2015, were reviewed.
Results:
Twenty-five children were identified. Median age at presentation was 5.4years. Four were initially diagnosed with CD (16%), 14 with ulcerative colitis (UC) (56%), and 7 with inflammatory bowel disease unclassified (IBD-U) (28%). Eight eventually had pouch surgery. Five of the children with an initial diagnosis of UC or IBD-U developed findings that changed the diagnosis to CD at a median age of 13.4 (range 10.3 to 16.7) years. None had any indicators of CD at the initial presentation.
Conclusions:
Approximately one quarter of patients with very early-onset colitis originally diagnosed as UC or IBD-U had a reclassification in diagnosis to CD over time. J-pouch reconstruction should be delayed until adolescence in children with very early-onset colitis.
Level Of Evidence:
2C.
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