Colectomy often required for children with severe ulcerative colitis

Last Updated: 2008-03-07 11:00:01 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Children with ulcerative colitis are more likely than adults to have extensive disease with severe exacerbations, a research team at the University of Toronto reports in the March issue of Gut. In only about half of the cases requiring hospitalization does the disease respond to intravenous corticosteroid therapy, their findings indicate, and many pediatric patients require colectomy.

Dr. Anne M. Griffiths and her associates reviewed rates of severe pediatric ulcerative colitis and predictors of response to IV corticosteroids in a cohort of children treated at Toronto's Hospital for Sick Children between 1991 and 2000.

The cohort included 99 children without intercurrent enteric pathogen infection requiring hospitalization, representing 28% of pediatric patients with ulcerative colitis residing in the Greater Toronto Area. The population-based incidence was 1 per 100,000 children per year.

Records showed that 53% of patients responded to IV corticosteroid therapy (methylprednisolone 1 to 1.5 mg/kg/day, usually up to 60 mg daily in 2 divided doses, or the equivalent dose of hydrocortisone). However, 22% of patients became steroid dependent during the following year.

Second-line therapies include infliximab, calcineurin inhibitors, and colectomy. In this case series, six patients were treated with cyclosporine or tacrolimus, and four responded.

The cumulative rates of colectomy were 42% at discharge, 58% at 1 year, and 61% at 6 years.

Scores on the Pediatric Ulcerative Colitis Activity Index (PUCAI) predicted colectomy by discharge and during long-term follow-up. The PUCAI score (maximum 85 points) is based on six factors - abdominal pain, rectal bleeding, stool consistency, number of stools per day, nocturnal stools, and activity level.

Dr. Griffiths' team advises that, for children hospitalized for severe ulcerative colitis, "a PUCAI score of > 45 on day 3 should dictate planning of second-line therapy, and a PUCAI score > 70 on day 5 should prompt the execution of the planned therapy."

Gut 2008;57:331-338.