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.
- intravenous corticosteroids
- ulcerative colitis