Alex Krauthammer1,2, Christos Tzivinikos3, Amit Assa2,4, Erasmo Miele5, Caterina Strisciuglio6, Darja Urlep7, Elena Daniela Serban8, Avantika Singh9, Harland S Winter9, Richard K Russell10, Iva Hojsak11, Mikkel Malham12, Víctor Manuel Navas-López13, Nicholas M Croft14,15, Huey Miin Lee15, Oren Ledder16, Ibrahim Shamasneh16, Seamus Hussey17, Hien Q Huynh18, Eytan Wine18, Neil Shah19, Margaret Sladek20, Tim G de Meij21, Claudio Romano22, Valeria Dipasquale22, Paolo Lionetti23, Nadeem A Afzal24, Marina Aloi25, Kwangyang Lee26, Javier Martín-de-Carpi27, Anat Yerushalmy-Feler2,28, Sreedhar Subramanian29, Batia Weiss1,2, Dror S Shouval1,2. 1. Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Paediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK. 4. Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Centre of Israel, Petah Tiqwa, Israel. 5. Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Italy. 6. Department of Woman, Child and General and Specialistic Surgery, University of Campania, "Luigi Vanvitelli"Naples, Italy. 7. Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia. 8. Second Department of Paediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania. 9. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Boston, MA, USA. 10. Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK. 11. Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia. 12. Paediatric Department, Hvidovre University Hospital, Hvidovre, Denmark. 13. Pediatric Gastroenterology and Nutrition Unit, Hospital Materno, IBIMA, Malaga, Spain. 14. Barts and the London School of Medicine, Queen Mary University of London, London, UK. 15. Department of Paediatric Gastroenterology, Royal London Children's Hospital, Barts Health NHS Trust, London, UK. 16. Juliet Keidan Instutute of Pediatric Gastroenterology, Shaare Zedek Medical Centre, Hebrew University of Jerusalem, Jerusalem, Israel. 17. National Children's Research Centre, Royal College of Surgeons of Ireland, Dublin, Ireland. 18. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. 19. Department of Paediatric Gastroenterology, Great Ormond Street Hospital London, London, UK. 20. Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland. 21. Department of Paediatric Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 22. Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy. 23. Gastroenterology Unit, University of Florence, Department of "NEUROFARBA": Section of Child's Health, "Anna Meyer" Children's Hospital, Florence, Italy. 24. Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK. 25. Sapienza University of Rome, Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Rome, Italy. 26. Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK. 27. Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain. 28. Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv, Israel. 29. Department of Gastroenterology, Royal Liverpool University Hospital and University of Liverpool, Liverpool, UK.
Abstract
BACKGROUND AND AIM: Acute severe colitis [ASC] is associated with significant morbidity in paediatric patients with ulcerative colitis [UC]. Most outcome studies in ASC since tumour necrosis factor alpha [TNFα] antagonists became available have focused on the first year after admission. The aim of this study was to characterise the longer-term outcomes of paediatric patients admitted with ASC. METHODS: This retrospective study was conducted in 25 centres across Europe and North America. Data on patients with UC aged <18 years, admitted with ASC (defined as paediatric ulcerative colitis activity index [PUCAI] score ≥65) between 2009 and 2011, were collected at discharge and 1, 3 and 5 years after admission. The primary outcome was colectomy-free rates at each time point. RESULTS: Of the 141 patients admitted with ASC, 137 [97.1%] were treated with intravenous corticosteroids. Thirty-one [22.6%] patients were escalated to second-line therapy, mainly to infliximab. Sixteen patients [11.3%] underwent colectomy before discharge. Long-term follow-up showed colectomy-free rates were 71.3%, 66.4% and 63.6% at 1, 3 and 5 years after initial ASC admission, respectively, and were similar across different age groups. Sub-analysis of colectomy rates in patients with new-onset disease [42.5% of the cohort] yielded similar results. In a multivariate analysis, use of oral steroids in the 3 months before admission, erythrocyte sedimentation rate >70 mm/h, and albumin <2.5 g/dL, were significantly associated with 5-year colectomy risk. CONCLUSIONS: High colectomy rates were demonstrated in paediatric UC patients admitted with ASC. Additional studies are required to determine whether intensification of anti-TNFα treatment, close therapeutic drug monitoring, and use of new drugs alter this outcome.
BACKGROUND AND AIM: Acute severe colitis [ASC] is associated with significant morbidity in paediatric patients with ulcerative colitis [UC]. Most outcome studies in ASC since tumour necrosis factor alpha [TNFα] antagonists became available have focused on the first year after admission. The aim of this study was to characterise the longer-term outcomes of paediatric patients admitted with ASC. METHODS: This retrospective study was conducted in 25 centres across Europe and North America. Data on patients with UC aged <18 years, admitted with ASC (defined as paediatric ulcerative colitis activity index [PUCAI] score ≥65) between 2009 and 2011, were collected at discharge and 1, 3 and 5 years after admission. The primary outcome was colectomy-free rates at each time point. RESULTS: Of the 141 patients admitted with ASC, 137 [97.1%] were treated with intravenous corticosteroids. Thirty-one [22.6%] patients were escalated to second-line therapy, mainly to infliximab. Sixteen patients [11.3%] underwent colectomy before discharge. Long-term follow-up showed colectomy-free rates were 71.3%, 66.4% and 63.6% at 1, 3 and 5 years after initial ASC admission, respectively, and were similar across different age groups. Sub-analysis of colectomy rates in patients with new-onset disease [42.5% of the cohort] yielded similar results. In a multivariate analysis, use of oral steroids in the 3 months before admission, erythrocyte sedimentation rate >70 mm/h, and albumin <2.5 g/dL, were significantly associated with 5-year colectomy risk. CONCLUSIONS: High colectomy rates were demonstrated in paediatric UC patients admitted with ASC. Additional studies are required to determine whether intensification of anti-TNFα treatment, close therapeutic drug monitoring, and use of new drugs alter this outcome.
Authors: Jeffrey S Hyams; Michael Brimacombe; Yael Haberman; Thomas Walters; Greg Gibson; Angela Mo; David Mack; Anne Griffiths; Brendan Boyle; Neal LeLeiko; James Markowitz; Joel Rosh; Ashish Patel; Sapana Shah; Robert Baldassano; Marian Pfefferkorn; Cary Sauer; Joelynn Dailey; Suresh Venkateswaran; Subra Kugathasan; Lee A Denson Journal: Inflamm Bowel Dis Date: 2022-02-01 Impact factor: 5.325