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DOP037. Long-term outcome of paediatric-onset ulcerative colitis: early years are shaping the future

C. Gower-Rousseau1,2, H. Sarter3, D. Turck4, M. Fumery5, E. Laberenne6, F. Vasseur1, L. Peyrin-Biroulet7, J.-F. Colombel8, G. Savoye9, A. Peneau10, C. Spyckerelle11, 1University and Hospital, Epidemiology, Lille, France, 2Health, Epidemiology, Lille, France, 3University and Hospital, Epimad Registry Biostatistics EA 2694, Lille, France, 4University and Hospital, Paediatric, Lille, France, 5University and Hospital, Gastroenterology, Amiens, France, 6Hospital, Gastroenterology, Seclin, France, 7University and Hospital, Gastroenterology, Nancy, France, 8Hemsley Inflammatory Bowel Disease Center, Icahn Medical School of Medicine at Mount Sinai, New-York, United States, 9University and Hospital, Gastroenterology, Rouen, France, 10University and Hospital, Gastroenterology, Lille, France, 11Catholic University & Hospital, Paediatric, Lille, France

Background

Data on long-term outcome of paediatric-onset ulcerative colitis (UC) are scarce.

Methods

All patients recorded by the EPIMAD Registry between 1988 and 2004 with a diagnosis of UC before the age of 17 years were included. The cumulative risks of receiving immunosuppressants (IS, including azathioprine and/or methotrexate and/or cyclosporine) and anti-TNF therapy, as well as undergoing colectomy were estimated via the Kaplan–Meier method.

Results

159 paediatric-onset UC patients with a follow-up more than 2 years were identified (5% of all cases of UC), including 92 females. Twenty-two children (14%) had less than 10 years at UC diagnosis. Median age at diagnosis was 14.5 years [IQR: 11.4–16.1] and median duration of follow-up was 11.5 years [8.2–15.8]. At diagnosis 25% of children had proctitis (E1), 38% left-sided colitis (E2) and 37% extensive colitis (E3). Disease course was characterised by disease extension in 50% of patients (50 among 101 E1 and E2). Cumulative risks of colonic extension were 11% at 1 year, 48% at 5 years, 54% at 10 years and 57% at 15 years. At diagnosis 12 (7.6%) patients had extra intestinal manifestations and 40 (25%) at maximal follow-up including articular manifestations (n = 27). Cumulative probabilities of receiving IS and anti-TNF therapy were respectively 20% and 0.5% at 2 years, 28% and 4% at 5 years, 32% and 7% at 10 years and 35% and 13% at 15 years. Cumulative probabilities of colectomy were 6% at 1 year, 20% at 5 years, 21% at 10 years and 24% at 15 years.

Conclusion

In this large population-based cohort of paediatric-onset UC disease the rate of disease extension and colectomy rapidly increased within the first 6 years after diagnosis and then remained stable. These data emphasize the need for early intervention to modify the natural history of paediatric UC.