AI Article Synopsis
- Ulcerative proctitis (UP) is a rare form of ulcerative colitis in children, with the study analyzing clinical features and outcomes of 196 diagnosed patients aged under 18 from 2016 to 2020.
- Most patients presented with symptoms like bloody stools and abdominal pain, and the study found that higher initial disease activity scores (PUCAI) were linked to worse outcomes, including the need for more aggressive treatments.
- By the end of the study, nearly half of the patients showed disease progression, and only a small percentage required colectomy, highlighting the challenges in managing UP in pediatric patients.
Article Abstract
Background And Aims: Ulcerative proctitis [UP] is an uncommon presentation in paediatric patients with ulcerative colitis. We aimed to characterize the clinical features and natural history of UP in children, and to identify predictors of poor outcomes.
Methods: This was a retrospective study involving 37 sites affiliated with the IBD Porto Group of ESPGHAN. Data were collected from patients aged <18 years diagnosed with UP between January 1, 2016 and December 31, 2020.
Results: We identified 196 patients with UP (median age at diagnosis 14.6 years [interquartile range, IQR 12.5-16.0]), with a median follow-up of 2.7 years [IQR 1.7-3.8]. The most common presenting symptoms were bloody stools [95%], abdominal pain [61%] and diarrhoea [47%]. At diagnosis, the median paediatric ulcerative colitis activity index [PUCAI] score was 25 [IQR 20-35], but most patients exhibited moderate-severe endoscopic inflammation. By the end of induction, 5-aminosalicylic acid administration orally, topically or both resulted in clinical remission rates of 48%, 48%, and 73%, respectively. The rates of treatment escalation to biologics at 1, 3, and 5 years were 10%, 22%, and 43%, respectively. In multivariate analysis, the PUCAI score at diagnosis was significantly associated with initiation of systemic steroids, or biologics, and subsequent acute severe colitis events and inflammatory bowel disease-associated admission, with a score ≥35 providing an increased risk for poor outcomes. By the end of follow-up, 3.1% of patients underwent colectomy. Patients with UP that experienced proximal disease progression during follow-up [48%] had significantly higher rates of a caecal patch at diagnosis and higher PUCAI score by the end of induction, compared to those without progression.
Conclusion: Paediatric patients with UP exhibit high rates of treatment escalation and proximal disease extension.
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| http://dx.doi.org/10.1093/ecco-jcc/jjad111 | DOI Listing |
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