Abstract
The impact of endoscopic and histological mucosal healing on outcomes in adult settings is impressive. Despite many clinical parallels, pediatric ulcerative colitis (UC) is set apart from adult disease in several respects. Many frequently used indices are not fully validated, especially in pediatric settings, and consensus on precise definitions in clinical settings are lacking. Endoscopic mucosal healing is an acceptable long-term treatment goal in pediatrics, but not histologic normalization. Early prediction of disease course in UC may allow treatment stratification of patients according to risks of relapse, acute severe colitis, and colectomy. Putative endoscopic and histologic predictors of poor clinical outcomes in adults have not held true in pediatric settings, including baseline endoscopic extent, endoscopic severity, and specific histologic characteristics which are less prevalent in pediatrics at diagnosis. In this mini-review we appraise predictive endoscopic and histologic factors in pediatric UC with reference to relapse, severe colitis, and colectomy risks. We recommend that clinicians routinely use endoscopic and histologic sores to improve the quality of clinical and research practice. The review summarizes differences between adult and pediatric prediction data, advises special consideration of those with primary sclerosing cholangitis, and suggests areas for future study in this field.
Highlights
Ulcerative colitis (UC) is a chronic inflammatory intestinal disorder, with a relapsing and remitting course
While many patients successfully respond to first line treatments, others will progress through medically refractory disease to colectomy
The higher prevalence of relative rectal sparing in pediatrics may account for some discrepancy from adult data, but structured and centralized reading of endoscopic appearances in future pediatric studies is essential to control for otherwise avoidable variability and weaknesses in endoscopic scoring data
Summary
Predicting risks of relapse, severe colitis, and colectomy in adults using endoscopic and histologic data has shown early promise. The tools used have not undergone pediatric validation. Endoscopic severity poorly predicts short- and medium-term risks of relapse, medication use, and colectomy in pediatrics. Histologic features associated with poorer short- to medium-term outcomes in pediatric UC include low rectal eosinophil counts and surface villiform changes at diagnosis. Stool biomarkers may identify children with endoscopic healing, a long-term treatment goal
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
