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- Title
The Natural History of Pediatric Ulcerative Colitis: A Population-Based Cohort Study.
- Authors
Gower-Rousseau, Corinne; Dauchet, Luc; Vernier-Massouille, Gwénola; Tilloy, Emmanuelle; Brazier, Franck; Merle, Véronique; Dupas, Jean-Louis; Savoye, Guillaume; Baldé, Mamadou; Marti, Raymond; Lerebours, Éric; Cortot, Antoine; Salomez, Jean-Louis; Turck, Dominique; Colombel, Jean-Frédéric
- Abstract
OBJECTIVES:The natural history of ulcerative colitis (UC) has been poorly described in children.METHODS:In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 113 UC patients (age 0–17 years at diagnosis) with a follow-up of at least 2 years. The cumulative risk of colectomy was estimated by the Kaplan–Meier method. Risk factors for disease extension were assessed with logistic regression models, and risk factors for colectomy with Cox hazards proportional models.RESULTS:Median follow-up time was 77 months (46–125). At diagnosis, 28% of patients had proctitis, 35% left-sided colitis, and 37% extensive colitis. Disease course was characterized by disease extension in 49% of patients. A delay in diagnosis of more than 6 months and a family history of inflammatory bowel disease were associated with an increased risk of disease extension, with odds ratios of 5.0 (1.2–21.5) and 11.8 (1.3–111.3), respectively. The cumulative rate of colectomy was 8% at 1 year, 15% at 3 years, and 20% at 5 years. The presence of extra-intestinal manifestations (EIMS) at diagnosis was associated with an increased risk of colectomy (hazard ratio (HR)=3.5 (1.2–10.5)). Among the patients with limited disease at diagnosis, the risk of colectomy was higher in those who experienced disease extension than in those who did not (HR=13.3 1.7–101.7).CONCLUSIONS:Pediatric UC was characterized by widespread localization at diagnosis and a high rate of disease extension. Twenty percent of children had their colon removed after 5 years. The colectomy rate was influenced by disease extension and was associated with the presence of EIMS at diagnosis.Am J Gastroenterol 2009; 104:2080–2088; doi:10.1038/ajg.2009.177; published online 12 May 2009
- Subjects
ULCERATIVE colitis in children; INFLAMMATORY bowel disease treatment; COLECTOMY; RECTUM examination; CROHN'S disease; DISEASE risk factors; PATIENTS
- Publication
American Journal of Gastroenterology (Springer Nature), 2009, Vol 104, Issue 8, p2080
- ISSN
0002-9270
- Publication type
Article
- DOI
10.1038/ajg.2009.177