Long-Term Course and Prognostic Factors in Pediatric Ulcerative Proctitis: A Multicenter Cohort Study

Area of Science:

• Pediatric Gastroenterology
• Inflammatory Bowel Disease Research
• Clinical Pediatrics

Background:

• Ulcerative proctitis (UP) in children is often mild, but some cases involve proximal disease extension and necessitate immunosuppressive therapy.
• Investigated clinical characteristics and outcomes of refractory pediatric UP in a multicenter cohort.

Purpose of the Study:

• To elucidate the natural history of refractory ulcerative proctitis in children.
• To identify factors predicting the need for immunosuppressive treatment in pediatric UP.

Main Methods:

• Retrospective analysis of data from 10 pediatric inflammatory bowel disease centers (2013-2022).
• Comparison of patients receiving immunosuppressants/biologics versus 5-aminosalicylic acid (5-ASA) monotherapy.
• Utilized Pediatric Ulcerative Colitis Activity Index and endoscopic assessments.

Main Results:

• 51% of patients experienced disease extension beyond the splenic flexure.
• 37% required immunosuppressive treatment, including 18% who received biologics.
• Time to sustained clinical remission (>3 months) predicted the need for biologics.

Conclusions:

• 5-aminosalicylic acid (5-ASA) suppositories are common initial treatments for pediatric UP but have poor compliance.
• A significant proportion (37%) of pediatric UP patients ultimately require immunosuppressive or biologic agents.
• Individualized treatment adjustment and close follow-up are essential for managing pediatric UP due to its variable clinical course.