Related Experiment Videos
Clinical outcome of ulcerative proctitis in children
1Department of Pediatrics, Hartford Hospital, Connecticut Children's Medical Center, Hartford, USA.
Insights
Pediatric ulcerative proctitis often presents mildly but carries a high risk of disease extension. Most children respond to therapy, but long-term monitoring is crucial for managing this condition.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
- Pediatric Colorectal Surgery
Background:
- Ulcerative proctitis course in adults is well-documented, but pediatric data is limited.
- Understanding pediatric ulcerative proctitis is essential for effective management.
Purpose of the Study:
- To characterize the presentation, treatment response, and long-term outcomes of ulcerative proctitis in children and adolescents.
- To identify risk factors for disease progression in pediatric ulcerative proctitis.
Main Methods:
- Retrospective chart review across five pediatric gastroenterology centers.
- Inclusion of 38 pediatric subjects with ulcerative proctitis.
Main Results:
- Most pediatric cases (74%) presented with mild symptoms; 29% experienced proximal disease extension.
- Symptom resolution occurred within 6 months for 92% of patients.
- Long-term follow-up revealed 54% of patients followed for over 5 years had proximal extension, with two requiring colectomy.
Conclusions:
- Pediatric ulcerative proctitis, despite mild initial presentation, has a significant risk of proximal disease extension.
- Therapeutic response in children mirrors that seen in pediatric ulcerative colitis.
- Endoscopic surveillance is recommended for pediatric ulcerative proctitis, particularly with persistent or recurrent symptoms.
Background:
Although the course of ulcerative proctitis in adults has been well described, little data are available concerning its clinical behavior in children and adolescents. This study sought to characterize the presentation, response to therapy, and long-term course of ulcerative proctitis in the pediatric population.
Methods:
A retrospective chart review was conducted at five pediatric gastroenterology centers.
Results:
A total of 38 subjects (mean age 11.6 years) were identified with ulcerative proctitis (mean follow-up 4.3 years). Symptoms were mild at diagnosis in 74% and moderate or severe in 26%. Thirty-two percent had a complaint of constipation at presentation. Cessation of symptoms was noted in 68% within 3 months of therapy, an additional 24% within 6 months, and 8% were still symptomatic despite 6 months of therapy. During any subsequent yearly follow-up interval, -55% of patients were asymptomatic, 40% had a chronic intermittent course, and < 5% were continuously symptomatic despite therapy. Eight subjects were treated with oral corticosteroids, one with 6-mercaptopurine, and one with cyclosporine. Extension of inflammation proximal to the rectosigmoid occurred in 11 of 38 subjects (29%), 0.5-11.3 years postdiagnosis. Seven of the 13 subjects (54%) followed for > or = 5 years had proximal extension of disease, and two had undergone colectomy.
Conclusions:
Despite a mild presentation in most subjects, ulcerative proctitis seems to have a high risk of proximal extension of disease. The overall response to therapy seems to be similar to that reported for ulcerative colitis in children. Follow-up endoscopic evaluation of patients with ulcerative proctitis seems warranted, especially in the setting of recurrent or recalcitrant symptoms.