Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study

Area of Science:

• Pediatric Gastroenterology
• Inflammatory Bowel Disease Research
• Microbiome Science

Background:

• Acute severe ulcerative colitis (ASUC) in children presents unique challenges in management and long-term outcomes.
• Understanding the initial presentation and treatment response is crucial for optimizing pediatric IBD care.

Purpose of the Study:

• To evaluate the outcomes of children with ASUC at their first presentation.
• To identify predictors for escalating therapy and long-term disease course.

Main Methods:

• Prospective follow-up of children (<17 years) with new-onset ASUC (Paediatric Ulcerative Colitis Activity Index [PUCAI] ≥65).
• Analysis of baseline fecal microbiome composition using 16S rRNA amplicon sequencing.
• Primary endpoint: corticosteroid-free clinical remission at 1 year.

Main Results:

• Of 105 children with ASUC, 51% were steroid-refractory and initiated infliximab; 61% achieved corticosteroid-free remission at 1 year.
• Gut microbiome in ASUC showed lower alpha-diversity, reduced beneficial anaerobes, and increased aerobes compared to mild UC.
• Hypoalbuminemia, higher PUCAI, older age, and male sex predicted the need for infliximab.

Conclusions:

• The majority of pediatric ASUC patients escalate therapy to biologics, often infliximab.
• Identifying predictors for advanced therapy can aid in selecting appropriate maintenance strategies for children with ASUC.