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Original article
Ulcerative proctitis is a frequent location of paediatric-onset UC and not a minor disease: a population-based study
  1. A Hochart1,
  2. C Gower-Rousseau2,3,
  3. H Sarter2,3,
  4. M Fumery2,4,
  5. D Ley1,2,
  6. C Spyckerelle5,
  7. L Peyrin-Biroulet6,
  8. J-E Laberenne7,
  9. F Vasseur8,
  10. G Savoye9,
  11. D Turck1,2
  12. on Behalf of Epimad Group
    1. 1Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Lille University and Hospital, France et Univ. Lille CHU Lille, Lille, France
    2. 2Lille Inflammation Research International Center LIRIC—UMR 995 Team 5, Inserm/Université Lille 2/CHRU de Lille, Lille, France
    3. 3Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille, Cedex, France
    4. 4Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, France
    5. 5Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Saint Vincent de Paul Hospital and Lille Catholic University, Lille, France
    6. 6Hepato-Gastroenterology Unit, Inserm, U954, Nancy University Hospital, France
    7. 7Hepato-Gastroenterology Unit, Epimad Registry, General Hospital, Seclin, France
    8. 8Department of Biostatistics, EA 2694, Lille University Hospital, France
    9. 9Gastroenterology Unit, Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
    1. Correspondence to Dr Corinne Gower-Rousseau, Department of Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, CS 70001, Lille, Cedex 59037, France; corinne.gower{at}chru-lille.fr

    Abstract

    Objective Natural history of paediatric-onset ulcerative proctitis (UP) is poorly described. Our aim was to describe the phenotype and disease course of incident UP in a population-based study of paediatric-onset UC.

    Patients and methods All patients with UC diagnosed <17 years from 1988 to 2004, and followed during >2 years have been extracted from a population-based registry. UC location was defined according to the Paris classification. Cumulative risks for use of immunosuppressants (IS), anti-tumour necrosis factor alpha (TNF-α) therapy, colonic extension and colectomy were described using Kaplan-Meier method. Risk factors for colonic extension were assessed using Cox proportional hazards models.

    Results 158 patients with paediatric-onset UC (91 females) with a median age at diagnosis of 14.5 years (Q1: 11.4–Q3: 16.1) have been identified and followed during a median of 11.4 years (8.2–15.8). Among them, 25% had UP (E1) at diagnosis and 49% of them presented a colonic extension at maximal follow-up. In these children, the cumulative risk for colonic extension was 10% at 1 year, 45% at 5 years and 52% at 10 years. No parameter at diagnosis was associated with colonic extension in the UP (E1 group). IS use was significantly lower in patients with UP than in those with E2, E3 or E4 location (p=0.049). For the UP cohort, the cumulative risk for colectomy was 3% at 1 year, 10% at 5 years, 13% at 10 years and 13% at 15 years. Risks for colonic extension, treatment with anti-TNF-α and colectomy did not differ between the E1 group and the E2–E3–E4 group.

    Conclusions UP is frequent in paediatric-onset UC and should not be considered as a minor disease. Compared with more extensive UC locations, risks for colonic extension, anti-TNF-α therapy and colectomy were similar in UP, whereas the risk for use of IM was lower.

    • ULCERATIVE COLITIS
    • EPIDEMIOLOGY
    • PAEDIATRIC GASTROENTEROLOGY

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