Ulcerative Colitis In Children Research Articles

Management of acute severe ulcerative colitis in children

The incidence of pediatric-onset ulcerative colitis (UC) is rising. Children often present with a more severe disease phenotype as compared to adults with over a third requiring hospitalization for the management of acute severe ulcerative colitis (ASUC). Further, in pediatric patients presenting with inflammatory bowel disease (IBD) limited to the colon, a definitive diagnosis of UC vs. Crohn’s disease is often unclear. Here, we review the unique aspects of pediatric ASUC including the epidemiology, diagnosis, medical, and surgical management of this disease.

A clinical characteristic of paediatric ulcerative colitis patients qualified for a Cyclosporin A therapy

BackgroundAccording to ECCO/ESPGHAN consensus for managing acute severe ulcerative colitis in children, Cyclosporin A remains a rescue therapy in acute steroid-refractory ulcerative colitis. AimTo describe clinical features of children qualified for Cyclosporin A (CsA) treatment. Material and methodsIt is a retrospective, single centre study. We describe a clinical characteristic of children who underwent CsA treatment in the course of ulcerative colitis (UC). ResultsWe evaluated 59 children's medical charts treated in our department with Cyclosporin A in the course of ulcerative colitis in years 2005–2015. There is a female predominance in the study (34/59). The median age at the diagnosis was 11.9 years, while the median age of the initiation of CsA 15 years. Ulcerative colitis had lasted on median 20 months when CsA was initiated. The median PUCAI score at the onset of CsA therapy was 50.00. Almost 80% of patients had a moderate/severe course. ConclusionCsA was in our department the drug of choice in case of steroid refractory ulcerative colitis.

Immunosuppressive medication is not associated with surgical site infection after surgery for intractable ulcerative colitis in children.

Pediatric ulcerative colitis (UC) sometimes progresses to an intractable condition for medical therapy. The surgical management of UC is challenging because of difficult procedures and frequent infectious complications. The aim of this study was to survey surgical procedures and infectious complications in pediatric patients with UC in Japan and to assess the relationship between preoperatively administered immunosuppressive drugs and postoperative surgical site infection (SSI). A survey of pediatric patients treated from 2000 to 2012 was sent to 683 facilities nationwide. Secondary questionnaires were sent to physicians who followed up patients with UC who had undergone surgery with the aim of assessing the relationships between postoperative SSI and selected preoperative patient characteristics, disease severity, medications, and operative procedures. Data for 136 patients (77 boys and 59 girls) were assessed. Median age at surgery was 14.1 years (range: 2.4-18.9 years). Surgery was performed in one stage in 35 cases, two stages in 57 cases, and three stages in 44 cases. SSI occurred in 36/136 patients (26%). According to multiple logistic regression analysis, there were statistically significant associations between SSI and staged surgery (three/one, OR: 6.7, 95% CI: 2.1-25.5, p = 0.0007; three/two, OR: 3.4, 95% CI: 1.4-8.6, p = 0.0069) and female sex (OR: 2.3, 95% CI: 1.0-5.4, p = 0.0434). Preoperative medications and incidence of SSI were not significantly associated. Preoperative immunosuppressive medication does not affect the incidence of SSI. Three-stage surgery and female sex are independent predictors of development of postoperative SSIs in pediatric patients with UC.

PSY88 - Treatment Gap of Ulcerative Colitis In Children And Adolescents In Poland - Cost-Utility Analysis of Biosimilar Infliximab

PSY88 - Treatment Gap of Ulcerative Colitis In Children And Adolescents In Poland - Cost-Utility Analysis of Biosimilar Infliximab

Ulcerative colitis in a Nigerian child: case report

Ulcerative colitis (UC) is a chronic re-occuring inflammatory disease affecting mainly the colon. It is more prevalent in the United Kingdom, North America Scandinavia and less common in southern Europe, Asia and Africa. Commonly, UC is suspected in patients presenting with bloody diarrhoea, tenesmus, abdominal pain, and, when severe, weight loss, fatigue, and vomiting. Perhaps one child so far with UC has been reported southwest geo-political zone of Nigeria. We here report the first case of ulcerative colitis in a child in south-south Nigeria.The objective of this report was to highlight the occurence of ulcerative colitis in a Nigerian child in the setting of poor sociopsychological/economic background coupled with difficulty in investigating patient to arrive at a diagnosis. An 11 year old Nigerian male child who was referred to the University of Calabar Teaching Hospital with bleeding per rectum, abdominal pain and swelling, bilateral leg swelling and weight loss for seven months prior to presentation. Examination and investigations done including colonoscopy, histology of biopsy, faecal calprotectin and pANCA confirmed ulcerative colitis. Ulcerative colitis though rare in Africa may have been missed in some children due to mis-conception and lack of diagnostic facilities/expertise. We may begin to see more of this with increasing interest in the subspecialty of paediatric gastroenterology and presence of diagnostic facilities.Keyword: Ulcerative Colitis, Diagnostic difficulties, Nigerian child

The putative role of gut microbiota in primary sclerosing cholangitis and ulcerative colitis in children

The putative role of gut microbiota in primary sclerosing cholangitis and ulcerative colitis in children

The incidence of Crohn’s disease and ulcerative colitis since 1995 in Danish children and adolescents

Objective: Worldwide the incidence of pediatric Crohn’s disease (CD) and ulcerative colitis (UC) is suspected to be increasing. Based on unselected nationwide register data the aim of this study is to examine the change in incidence of CD and UC in children and adolescents in Denmark.Materials and methods: All children and adolescents <17 years with a diagnosis of CD or UC registered in the Danish National Patient Registry from 1 January 1995 to 31 December 2013 were included. Using a Poisson regression model we estimated the incidence rate ratio (IRR) for the annual change in the incidence adjusted for gender and age. The cumulative incidence was described using Kaplan–Meier survival analyses.Results: The IRR for CD was 1.052 (95% CI: 1.039–1.065), and for UC the IRR was 1.022 (95% CI: 1.011–1.033), adjusted for age and gender. The incidence rate of CD increased during the study period to 10.0 (95% CI: 7.5–13.2) per 100,000 person years for girls and 9.4 (95% CI: 7.0–13.2) for boys, in 2013. Similar, the incidence of UC increased to 7.2 (95% CI: 5.0–9.9) per 100,000 person years for girls and 6.2 (95% CI: 4.3–8.7) for boys.Conclusions: In a period of 19 years from 1995 to 2013 we found an increasing incidence for pediatric UC and CD, especially pronounced for CD.

634 Serologic Reactivity Reflects Clinical and Genetic Expression of Ulcerative Colitis in Children. The Protect Study

634 Serologic Reactivity Reflects Clinical and Genetic Expression of Ulcerative Colitis in Children. The Protect Study

Long-term follow up of ileal pouch anal anastomosis in a large cohort of pediatric and young adult patients with ulcerative colitis

AimThe study's aim is to determine long-term outcomes in a large cohort of pediatric and young adult patients who underwent proctocolectomy with ileal pouch anal anastomsis (IPAA) for ulcerative colitis (UC). MethodsPatients diagnosed with UC in childhood or adolescence (age≤21years) who underwent IPAA in childhood, adolescence, or young adulthood between 1982 and 1997 were contacted to determine pouch history, complications, and quality of life. ResultsData were obtained from 74 patients out of a previously reported cohort. Median age at diagnosis of UC was 15years and at surgery was 18years. Median follow-up was 20years. Complications during follow-up were pouchitis (45%), strictures (16%), fistulae (30%), obstruction (20%), and change of diagnosis to Crohn's (28%). Twenty-three percent reported no complications. Fourteen percent had pouch failure, with Crohn's and fistulae reported to be the most frequent complications. Seventy-nine percent reported being very satisfied at 20years follow-up. ConclusionTo our knowledge, this study represents the largest cohort with the longest follow-up of pediatric and young adult patients undergoing IPAA for UC. Change in diagnosis to Crohn's and development of fistulae are risk factors for pouch failure. Despite reported complications, IPAA remains an excellent option for pediatric patients with UC.

50 Years Ago in TheJournal ofPediatrics: Chronic Ulcerative Colitis in Childhood: An Evaluative Review

50 Years Ago in TheJournal ofPediatrics: Chronic Ulcerative Colitis in Childhood: An Evaluative Review

Characteristics of pediatric ulcerative colitis in Saudi Arabia: a multicenter national study.

BACKGROUNDDespite the extensive reporting of pediatric ulcerative colitis (UC) from industrialized developed countries, reports from developing countries are limited to small-case series from single centers. The objective of our large multicenter study was to determine the clinical, laboratory, endoscopic characteristics of UC in children from a developing country, Saudi Arabia.DESIGN AND SETTINGSA retrospective study of children diagnosed with UC under the age of 18 years during the period from 2003 to 2012.METHODSPatients enrolled from 15 medical centers from different regions in Saudi Arabia. A unified database collection form specifically designed for this study was completed by all participating centers.RESULTSA total of 188 children were diagnosed with UC during the study period (97 males [51.6%] and 91 females [48.4%]). The mean age at diagnosis was 9.1 years, and the mean duration of symptoms before diagnosis was 8.7 months. Consanguinity was present in 57 cases (32.6%), and the family history of inflammatory bowel disease (IBD) was noted in 16 cases (9%). The most common clinical presentation was blood in stool (90%), followed by diarrhea (86%) and abdominal pain (62%). Laboratory investigations revealed elevated erythrocyte sedimentation rate (82%), anemia (75%), thrombocytosis (72%), and hypoalbuminemia (33%). The extent of the disease was pan colonic in 46.1%, and confined to left side of colon and rectum in 23% and 9.6% of the cases, respectively.CONCLUSIONThis demographically pediatric IBD retrospective study revealed age-related variation in the distribution of IBD. Clinical presentation, with a high prevalence of positive consanguinity and positive family history, was noted in young patients with UC. The data from this study indicate that UC is increasingly recognized in Saudi Arabia and show many similarities to data from North America and Europe.

High- and low-dose oral delayed-release mesalamine in children with mild-to-moderately active ulcerative colitis.

ABSTRACTObjective:The aim of the study was to assess the safety and efficacy of high- and low-dose oral, delayed-release mesalamine in a randomized, double-blind, active control study of children with mild-to-moderately active ulcerative colitis.Methods:Patients ages 5 to 17 years, with a Pediatric Ulcerative Colitis Activity Index (PUCAI) score of ≥10 to ≤55 and a truncated Mayo Score of ≥1 for both rectal bleeding and stool frequency, were enrolled. They received body weight–dependent doses of oral, delayed-release mesalamine for 6 weeks in a low- (27–71 mg · g−1 · day−1) or high-dose group (53–118 mg · g−1 · day−1). The primary endpoint was treatment success, defined as the proportion of patients who achieved remission (PUCAI score <10) or partial response (PUCAI score ≥10 with a decrease from baseline by ≥20 points). Secondary endpoints included truncated Mayo Score and global assessment of change of disease activity.Results:The modified intent-to-treat population included 81 of 83 patients enrolled. Treatment success by PUCAI was achieved by 23 of 41 (56%) and 22 of 40 (55%) patients in the mesalamine low- and high-dose groups, respectively (P = 0.924). Truncated Mayo Score (low-dose 30 [73%] and high-dose 28 [70%] patients) and other efficacy results did not differ between the groups. The type and severity of adverse events were consistent with those reported in previous studies of adults with ulcerative colitis and did not differ between groups.Conclusions:Both low- and high-dose oral, delayed-release mesalamine doses were equally effective as short-term treatment of mild-to-moderately active ulcerative colitis in children, without a specific benefit or risk to using either dose.

Neutrophil gelatinase‐associated lipocalin in blood in children with inflammatory bowel disease

Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa glycoprotein present in the bodily fluids and tissues. It is secreted by neutrophils, epithelial cells, hepatocytes and adipocytes, and its expression is highly increased in response to cellular stress. The role of NGAL in the pathophysiology of inflammatory bowel disease including Crohn's disease and ulcerative colitis in children has thus far not been studied. The following groups of children were included: (i) inflammatory bowel disease group, n = 36, aged from 1 to 18 years with Crohn's disease (n = 19) and ulcerative colitis (n = 17); (ii) control group, n = 126; and (iii) disease control group, n = 27, without inflammatory bowel disease, with a food and/or inhalant allergy. Healthy children aged from 1 to 8 years exhibited lower NGAL level than those of 9 to 18 years old (39.0; 18.1-83.7 ng/mL vs 57.6; 28.7-107 ng/mL, P = 0.001). In the younger, but not in the older children, the serum NGAL level correlated with their age, r = 0.334, P = 0.001. In children with inflammatory bowel disease, serum NGAL level was higher (108; 37.3-245 ng/mL) than in healthy (42.0; 18.1-107 ng/mL) and allergic, noninflammatory bowel disease children (49.3; 19.3-107 ng/mL), P = 0.001. Serum NGAL levels in Crohn's disease and ulcerative colitis children did not correlate with age, gender, disease activity, and indices of the inflammation. Serum NAGL levels are highly elevated in Crohn's disease and ulcerative colitis in children compared to the healthy control group. Systematic studies are needed to explain the role of this protein in the inflammatory bowel disease.

Cecitis With Proctitis: Unusual Pretreatment Presentation of Ulcerative Colitis in Childhood, Potential Diagnostic Pitfalls in an Atypical Presentation

Cecitis With Proctitis: Unusual Pretreatment Presentation of Ulcerative Colitis in Childhood, Potential Diagnostic Pitfalls in an Atypical Presentation

P-106: The clinical relevance of tacrolimus for ulcerative colitis in children: a national survey of the treatments for pediatric inflammatory bowel disease in Japan

P-106: The clinical relevance of tacrolimus for ulcerative colitis in children: a national survey of the treatments for pediatric inflammatory bowel disease in Japan

P-107: Effect of exclusive enteral nutrition on the course of CD and intestinal microbiota

P-107: Effect of exclusive enteral nutrition on the course of CD and intestinal microbiota

P-055: The natural history of pediatric IBD according to the Paris classification

P-055: The natural history of pediatric IBD according to the Paris classification

P-056: Buccal epithelial cell chemokine release as a biomarker for clinical response to therapy in inflammatory bowel disease

P-056: Buccal epithelial cell chemokine release as a biomarker for clinical response to therapy in inflammatory bowel disease

Consider disease severity and response to corticosteroids when selecting agents to manage ulcerative colitis in children

The primary objective in the management of paediatric ulcerative colitis is the induction and maintenance of disease remission. Induction is achieved primarily with aminosalicylates in patients with mild disease and with corticosteroids in those with moderate or severe disease. Maintenance options include aminosalicylates, immunomodulators and biological agents. Rescue therapy with calcineurin inhibitors or infliximab should be considered in those unresponsive to corticosteroids.

Capsule Colonoscopy Can Evaluate Ulcerative Colitis in Children

In a prospective pilot study, investigators assessed the diagnostic accuracy of second-generation colon capsule endoscopy in evaluating disease