AI Article Synopsis
- The study examines the timing of J-pouch surgery in children with early-onset colitis, debating between early vs. delayed reconstruction due to concerns over Crohn's disease (CD).
- It reviewed 25 children diagnosed with noninfectious colitis prior to age 10 and found that 16% were initially diagnosed with CD, while 56% had ulcerative colitis, and 28% had inflammatory bowel disease unclassified.
- Over time, 25% of those initially diagnosed with ulcerative colitis or inflammatory bowel disease unclassified were later reclassified to CD, suggesting that J-pouch surgery should be postponed until adolescence to better assess the diagnosis.
Article Abstract
Purpose: The timing of J-pouch surgery following colectomy for children with very early-onset colitis is controversial, with some advocating early reconstruction and others delaying reconstruction because of fear that the colitis may be owing to Crohn's disease (CD). We sought to determine the long-term incidence of CD in this population and whether there may be clinical features that predict the risk of CD.
Methods: Children with noninfectious colitis diagnosed prior to age 10, who underwent subtotal colectomy and ileostomy from 2000 to 2015, were reviewed.
Results: Twenty-five children were identified. Median age at presentation was 5.4years. Four were initially diagnosed with CD (16%), 14 with ulcerative colitis (UC) (56%), and 7 with inflammatory bowel disease unclassified (IBD-U) (28%). Eight eventually had pouch surgery. Five of the children with an initial diagnosis of UC or IBD-U developed findings that changed the diagnosis to CD at a median age of 13.4 (range 10.3 to 16.7) years. None had any indicators of CD at the initial presentation.
Conclusions: Approximately one quarter of patients with very early-onset colitis originally diagnosed as UC or IBD-U had a reclassification in diagnosis to CD over time. J-pouch reconstruction should be delayed until adolescence in children with very early-onset colitis.
Level Of Evidence: 2C.
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| http://dx.doi.org/10.1016/j.jpedsurg.2018.02.023 | DOI Listing |
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