OBJECTIVES: To characterize the response to current medical therapies in children with ulcerative colitis, and to identify those factors that may predict the need for colectomy. DESIGN: Retrospective chart review at two large pediatric inflammatory bowel disease centers. RESULTS: We identified 171 subjects ranging in age from 1.5 to 17.7 years at diagnosis (mean 11.2 years). Mean follow-up was 5.1 years. Of these subjects, 43% had mild disease at presentation and 57% had disease that was classified as moderate or severe. After treatment 90% of the former group and 81% of the latter group had resolution of symptoms by 6 months. During any subsequent yearly follow-up interval, approximately 55% of the entire study population was symptom free, 38% had chronic intermittent symptoms, and 7% had continuous symptoms. A significantly lower risk of colectomy was noted for those with initially mild disease compared with those with moderate/severe disease. At 1-year the risk of colectomy was 1% among those with mild disease versus 8% with moderate/severe disease; at 5 years, the risk of colectomy was 9% in the mild disease group versus 26% in the moderate/severe disease group (p <0.03). CONCLUSIONS: In the majority of pediatric subjects with ulcerative colitis remission is achieved in the first 6 months after therapy; thereafter disease is inactive in about 50% of patients during any given year of follow-up. Severity of disease at presentation is a significant risk factor for colectomy during the first 5 years of follow-up. Future management protocols with more aggressive initial therapy may be warranted in children with moderate/severe disease.
OBJECTIVES: To characterize the response to current medical therapies in children with ulcerative colitis, and to identify those factors that may predict the need for colectomy. DESIGN: Retrospective chart review at two large pediatric inflammatory bowel disease centers. RESULTS: We identified 171 subjects ranging in age from 1.5 to 17.7 years at diagnosis (mean 11.2 years). Mean follow-up was 5.1 years. Of these subjects, 43% had mild disease at presentation and 57% had disease that was classified as moderate or severe. After treatment 90% of the former group and 81% of the latter group had resolution of symptoms by 6 months. During any subsequent yearly follow-up interval, approximately 55% of the entire study population was symptom free, 38% had chronic intermittent symptoms, and 7% had continuous symptoms. A significantly lower risk of colectomy was noted for those with initially mild disease compared with those with moderate/severe disease. At 1-year the risk of colectomy was 1% among those with mild disease versus 8% with moderate/severe disease; at 5 years, the risk of colectomy was 9% in the mild disease group versus 26% in the moderate/severe disease group (p <0.03). CONCLUSIONS: In the majority of pediatric subjects with ulcerative colitis remission is achieved in the first 6 months after therapy; thereafter disease is inactive in about 50% of patients during any given year of follow-up. Severity of disease at presentation is a significant risk factor for colectomy during the first 5 years of follow-up. Future management protocols with more aggressive initial therapy may be warranted in children with moderate/severe disease.
Authors: Jeffrey S Hyams; Sonia Davis Thomas; Nathan Gotman; Yael Haberman; Rebekah Karns; Melanie Schirmer; Angela Mo; David R Mack; Brendan Boyle; Anne M Griffiths; Neal S LeLeiko; Cary G Sauer; David J Keljo; James Markowitz; Susan S Baker; Joel Rosh; Robert N Baldassano; Ashish Patel; Marian Pfefferkorn; Anthony Otley; Melvin Heyman; Joshua Noe; Maria Oliva-Hemker; Paul A Rufo; Jennifer Strople; David Ziring; Stephen L Guthery; Boris Sudel; Keith Benkov; Prateek Wali; Dedrick Moulton; Jonathan Evans; Michael D Kappelman; M Alison Marquis; Francisco A Sylvester; Margaret H Collins; Suresh Venkateswaran; Marla Dubinsky; Vin Tangpricha; Krista L Spada; Bradley Saul; Jessie Wang; Jose Serrano; Kevin Hommel; Urko M Marigorta; Greg Gibson; Ramnik J Xavier; Subra Kugathasan; Thomas Walters; Lee A Denson Journal: Lancet Date: 2019-03-29 Impact factor: 79.321
Authors: Richard Ahrens; Amanda Waddell; Luqman Seidu; Carine Blanchard; Rebecca Carey; Elizabeth Forbes; Maria Lampinen; Tara Wilson; Elizabeth Cohen; Keith Stringer; Edgar Ballard; Ariel Munitz; Huan Xu; Nancy Lee; James J Lee; Marc E Rothenberg; Lee Denson; Simon P Hogan Journal: J Immunol Date: 2008-11-15 Impact factor: 5.422
Authors: David B Nicholas; Sylvia R Swan; Ted J Gerstle; Theresa Allan; Anne Marie Griffiths Journal: Health Qual Life Outcomes Date: 2008-12-17 Impact factor: 3.186