Journal article
Clinical outcome of ulcerative colitis with severe onset in children: a multicenter prospective cohort study
Journal of gastroenterology, Vol.58(5), pp.472-480
05/2023
DOI: 10.1007/s00535-023-01972-1
PMID: 36884071
Abstract
As best practices for treating children with severe-onset ulcerative colitis remain controversial in the era of biologic agents, we prospectively investigated treatments and outcomes in a multicenter cohort.
Using a Web-based data registry maintained in Japan between October 2012 and March 2020, we compared management and treatment outcomes in an S1 group defined by a Pediatric Ulcerative Colitis Activity Index of 65 or more points at diagnosis with those in an S0 group defined by an index value below 65.
Three hundred one children with ulcerative colitis treated at 21 institutions were included, with follow-up for 3.6 ± 1.9 years. Among them, 75 (25.0%) were in S1; their age at diagnosis was 12.3 ± 2.9 years, and 93% had pancolitis. Colectomy free rates in S1 were 89% after 1 year, 79% after 2, and 74% after 5, significantly lower than for S0 (P = 0.0003). Calcineurin inhibitors and biologic agents, respectively, were given to 53% and 56% of S1 patients, significantly more than for S0 patients (P < 0.0001). Among S1 patients treated with calcineurin inhibitors when steroids failed, 23% required neither biologic agents nor colectomy, similarly to the S0 group (P = 0.46).
Children with severe ulcerative colitis are likely to require powerful agents such as calcineurin inhibitors and biologic agents; sometimes colectomy ultimately proves necessary. Need for biologic agents in steroid-resistant patients might be reduced to an extent by interposing a therapeutic trial of CI rather than turning to biologic agents or colectomy immediately.
Details
- Title: Subtitle
- Clinical outcome of ulcerative colitis with severe onset in children: a multicenter prospective cohort study
- Creators
- Ryusuke Nambu - Saitama Children's Medical CenterKatsuhiro Arai - National Center For Child Health and DevelopmentTakahiro Kudo - Juntendo UniversityTakatsugu Murakoshi - Tokyo Metropolitan Children's Medical CenterReiko Kunisaki - Yokohama City University Medical CenterTatsuki Mizuochi - Kurume UniversitySawako Kato - Shinshu UniversityHideki Kumagai - Jichi Medical UniversityMikihiro Inoue - Fujita Health UniversityTakashi Ishige - Gunma UniversityTakeshi Saito - Chiba HospitalAtsuko Noguchi - Akita UniversityToshifumi Yodoshi - Okinawa Prefectural Chubu HospitalShin-Ichiro Hagiwara - Osaka Women's and Children's HospitalNaomi Iwata - Aichi Children's Health and Medical CenterShigeo Nishimata - Tokyo Medical UniversityFumihiko Kakuta - Miyagi Children's HospitalHitoshi Tajiri - Osaka Prefectural Medical CenterEitaro Hiejima - Kyoto University HospitalNariaki Toita - Sapporo Kosei General HospitalTakahiro Mochizuki - Osaka Police HospitalHirotaka Shimizu - National Center For Child Health and DevelopmentItaru Iwama - Saitama Children's Medical CenterYuri Hirano - National Center For Child Health and DevelopmentToshiaki Shimizu - Juntendo UniversityJPIBD-R
- Resource Type
- Journal article
- Publication Details
- Journal of gastroenterology, Vol.58(5), pp.472-480
- DOI
- 10.1007/s00535-023-01972-1
- PMID
- 36884071
- NLM abbreviation
- J Gastroenterol
- ISSN
- 0944-1174
- eISSN
- 1435-5922
- Language
- English
- Date published
- 05/2023
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9985214169502771
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