Mucosal Atrophy Predicts Poorer Outcomes in Pediatric Ulcerative Colitis-A National Inception Cohort Study
Emily Stenke1, Lorraine Stallard1, Sarah Cooper2,3
1From National Centre for Pediatric Gastroenterology, CHI-Crumlin, Dublin, Ireland.
Insights
Mucosal atrophy (MA) in pediatric ulcerative colitis (UC) predicts worse outcomes. Children with MA at diagnosis had higher colectomy rates, indicating MA is a key prognostic marker for pediatric UC.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Histopathology
Background:
- Pediatric ulcerative colitis (UC) outcomes are highly variable, necessitating reliable predictors of disease progression.
- Mucosal atrophy (MA), characterized by colonic intestinal gland abnormalities, is a potential histological marker.
Purpose of the Study:
- To investigate the prevalence of mucosal atrophy (MA) in a national cohort of newly diagnosed pediatric ulcerative colitis (UC) patients.
- To assess the impact of MA on clinical outcomes in pediatric UC.
Main Methods:
- A national inception cohort of pediatric UC patients (<16 years) underwent phenotyping and disease activity assessment at diagnosis.
- Colonic biopsies were evaluated for MA, and patients were prospectively followed for outcomes including corticosteroid-free remission, relapse, treatment escalation, and colectomy.
Main Results:
- 15% of 251 pediatric UC patients exhibited MA at diagnosis.
- Patients with MA showed similar initial remission rates but required higher steroid, immunomodulator, and biologic use.
- Mucosal atrophy was associated with earlier relapse and significantly higher colectomy rates by 2 years.
Conclusions:
- Mucosal atrophy at diagnosis is a significant prognostic marker in pediatric ulcerative colitis.
- Children with MA experience more aggressive disease courses, leading to higher colectomy rates despite intensified treatment.
Background:
Outcomes in pediatric ulcerative colitis (UC) are heterogeneous and predictors of disease course eagerly sought. Mucosal atrophy (MA) is characterized by histological abnormalities of colonic intestinal glands.
Objective:
To determine the prevalence of MA in a national inception cohort of pediatric UC and its impact on outcomes.
Methods:
Irish children < 16 years old with UC are diagnosed at a single referral center. At diagnosis, patients underwent phenotyping by Paris classification and activity assessment by Pediatric Ulcerative Colitis Activity Index. Biopsies from all colonic segments were evaluated for MA. Patients were followed prospectively. The primary outcome was corticosteroid-free remission at 1 year. Secondary outcomes included relapse, treatment escalation, and colectomy by 2 years.
Results:
Of 251 pediatric patients with UC (mean age 11.8 years, 55% male), 38 (15%) had MA on diagnostic biopsy. Baseline characteristics were similar between groups with/without MA and there was no difference in steroid-free remission or rates of moderate-severe UC at 1 year. Patients with MA had higher use of steroids (29% vs 15%, P = 0.04) and immunomodulators (40% vs 21%, P = 0.04) at 6 months, higher biologic use at 1 year (34% vs 16%, P = 0.03), earlier first relapse (mean ± SD 29.4 ± 26.1 vs 46.7 ± 43.4 weeks after diagnosis, P = 0.02), and higher colectomy rates by 2 years (21% vs 8%, P = 0.01).
Conclusions:
Children with MA at diagnosis had higher colectomy rates despite earlier treatment escalation and similar baseline severity scores. We identify MA as a promising new prognostic marker in children with newly diagnosed UC.
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