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P174. Pediatric ulcerative colitis; presenting features, therapeutic approach and disease course

J. Martín de Carpi1, H. Expósito de Mena1,2, G. Pujol Muncunill2, V. Varea Calderón2, 1Hospital Sant Joan de Déu, Barcelona, Spain, Pediatric Inflammatory Bowel Disease Unit, Barcelona, Spain, 2Hospital Sant Joan de Deu, Pediatric Gastroenterology and Nutrition Unit, Barcelona, Spain

Background

Pediatric ulcerative colitis (UC) usually has a more extensive and progressive clinical course than adult UC. Moreover, initial intensive therapies to induce remission are needed and surgery is earlier indicated. Our aim is to review the epidemiologic features and clinical outcomes observed in our pediatric UC patients.

Methods

Observational retrospective study of the UC patients (age <18 years) diagnosed over a 4-year period (2008–2012) in our pediatric IBD referral Unit. Epidemiological and clinical data, therapeutic management and outcomes were reviewed both at diagnosis and throughout the follow-up.

Results

48 UC patients (54.2% women) were diagnosed in this period (9.6 new diagnosis/year). Mean follow-up: 28 months (SD 17 mo). Median age at diagnosis: 12 years (p25–75 7.2–14). Clinical presentation at diagnosis: 92% rectal bleeding, 77% diarrhea, 50% abdominal pain, 42% weight loss. According to the Paris classification, 61.4% presented with pancolitis, 23.4% with proctosigmoiditis, 8.5% with left-side colitis and 6.4% with extensive colitis. Mean PUCAI (Pediatric Ulcerative Colitis Activity Index) at diagnosis was 45 points (SD 15.7), with 13.6% presenting with severe disease (PUCAI >65). Median diagnostic delay was 5 months (1–24). 36 patients (75%) received 5-aminosalicylates at disease onset; in 9 of these patients steroids were added due to poor response. Globally, 62.4% (n = 30) received steroids: 43.7% at disease onset and an additional 18.7% in the follow-up. 5 patients (10.4%) received cyclosporine after steroid-resistance at disease onset; 2 of them received infliximab after cyclosporine failure, without response and need for colectomy (4% of the whole group). The incidence of steroid-dependence and steroid-resistance at the end of the follow-up was 26% and 16%, respectively. 16% of the patients received thiopurines as maintenance treatment. Granulocyte apheresis was used in 5 steroid-dependent patients, with posterior effective steroid withdrawal. Throughout the follow-up, 35.4% presented at least with one severe relapse (S1). 41.6% (n = 20) did not show recurrence. Endoscopic follow-up was performed in 22 patients after clinical impairment or when considering a therapeutic change; 3 of them showed disease extension (pancolonic involvement).

Conclusion

UC in our patients have showed a similar pattern to those described in the literature, with extensive and aggressive disease course. However, a low rate of colectomy (4%) was observed, with failure of rescue therapy after steroid-resistance at diagnosis being the common circumstance. A large number of children are at risk for steroid-dependency.