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Severe paediatric ulcerative colitis: incidence, outcomes, and optimal timing for second line therapy
  1. Dan Turner (dan.turner{at}sickkids.ca)
  1. The Hospital for Sick Children, Canada
    1. Catharine M Walsh
    1. The Hospital for Sick Children, Canada
      1. Eric I Benchimol
      1. The Hospital for Sick Children, Canada
        1. Erika H Mann
        1. The Hospital for Sick Children, Canada
          1. Karen E Thomas
          1. The Hospital for Sick Children, Canada
            1. Christy Chow
            1. The Hospital for Sick Children, Canada
              1. Robin A McLernon
              1. The Hospital for Sick Children, Canada
                1. Thomas D Walters
                1. The Hospital for Sick Children, Canada
                  1. A Hillary Steinhart
                  1. Mount Sinai Hospital, Canada
                    1. Anne M Griffiths (anne.griffiths{at}sickkids.ca)
                    1. The Hospital for Sick Children, Canada

                      Abstract

                      Background: Despite the predominance of extensive disease in children with ulcerative colitis (UC), data concerning severe paediatric UC are sparse. We reviewed rates and predictors of response to intravenous-corticosteroid therapy in a single-centre cohort with long-term follow-up. Methods: 99 children (49% males; age 2-17 years) were hospitalized (1991-2000) for treatment of severe UC (90% extensive; 49% new onset UC). Clinical, laboratory and radiographic data were reviewed. A population-based subset was used to assess incidence. Predictors of corticosteroid response were analyzed using univariate and multivariate analyses at days 3 and 5 of therapy. Colectomy rates were calculated using Kaplan-Meier survival analyses. Results: 28% (95% CI 23-34%) of Greater Toronto Area-resident children with UC required admission for intravenous corticosteroid therapy, of whom 53 (53%; 95%CI 44-63%) responded. Several predictors were associated with corticosteroid failure, but in multivariable modeling only C-reactive protein (OR=3.5 (1.4-8.4)) and number of nocturnal stools (OR=3.2 (1.6-6.6)) remained significant at both days 3 and 5. The Pediatric UC Activity Index (PUCAI), Travis and Lindgren’s indices strongly predicted non-response. Radiographically, upper range of colonic luminal width was 40mm in children younger than 11 years versus 60mm in older patients. Cumulative colectomy rates at discharge, 1-year and 6 years were 42%, 58% and 61%, respectively. Conclusions: Children with UC commonly experience at least one severe exacerbation. Response to intravenous corticosteroid is poor. Prediction rules determined at day 3 should be used to screen for patients likely to fail corticosteroids and at day 5 to dictate the introduction of second line therapies.

                      • incidence
                      • intravenous corticosteroids
                      • outcome
                      • prediction
                      • ulcerative colitis

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