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Disease course of ulcerative proctitis in children: A population-based study on behalf of the SIGENP IBD Group
Massimo Martinelli1, Flora Fedele1, Claudio Romano2
1Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, Naples 80131, Italy.
Insights
Pediatric ulcerative proctitis (UP) shows similar outcomes to other ulcerative colitis locations. High disease activity at diagnosis predicts disease extension in children with UP.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Ulcerative Colitis Natural History
Background:
- The natural history of ulcerative proctitis (UP) in pediatric populations remains understudied.
- Understanding UP's course is crucial for effective pediatric IBD management.
Purpose of the Study:
- To compare the disease course of pediatric ulcerative proctitis (UP) with other ulcerative colitis (UC) locations.
- To identify predictors of disease extension in children diagnosed with UP.
Main Methods:
- A multicenter, observational study using the SIGENP-IBD-Registry.
- Included children with UC and at least a 1-year follow-up.
- Identified UP patients using the Paris classification and compared them to other disease locations.
Main Results:
- Of 872 children, 78 (9%) had UP. Disease extension probabilities at 1, 5, and 10 years were higher in the E1 group (20.3%, 52.7%, 72.4%) compared to the E3 group (8.5%, 24.9%, 60.1%).
- No significant differences in extension were found between E1 and E2 groups.
- High Pediatric Ulcerative Colitis Activity Index (PUCAI > 35) at diagnosis predicted endoscopic extension (HR=4.9).
Conclusions:
- Pediatric ulcerative proctitis (UP) demonstrates comparable short- and long-term outcomes to other ulcerative colitis disease locations.
- Disease activity at diagnosis is a key factor influencing disease progression in pediatric UP.
Background:
The natural history of ulcerative proctitis (UP) has been poorly investigated in children.
Aims:
We aimed to compare the disease course of children with UP at diagnosis to the other locations and to identify extension predictors.
Methods:
This was a multicenter, observational study carried out from data prospectively entered in the SIGENP-IBD-Registry. Children with ulcerative colitis (UC) diagnosis and at least 1-year follow-up were included. On the basis of Paris classification UP patients were identified and compared with the other locations.
Results:
872 children were enrolled (median age at diagnosis: 11.2 years; M/F: 426/446), of whom 78 (9%) with UP. Kaplan-Meier analysis demonstrated increased cumulative probabilities of disease extension in the E1 group [1 year: 20.3%; 5 years: 52.7%; 10 years: 72.4%] compared to E3 group [1 year: 8.5%; 5 years: 24.9% and 10 years: 60.1%, p=0.001]. No differences were observed comparing E1 and E2 groups [p=0.4]. Cumulative probabilities of surgery at 1, 5 and 10 years were 1.3, 2.8 and 2.8% in the E1 group and 2.5, 8 and 12.8% in the E2-E3-E4 group, respectively (p=0.1). Cox regression analysis demonstrated that PUCAI>35 at diagnosis was associated with endoscopic extension (HR=4.9; CI 95% 1.5-15.2, p=0.006).
Conclusions:
UP is associated with similar short and long-term outcomes compared to other locations.
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