Ulcerative proctitis in pediatric-onset UC not 'a minor disease'

Last Updated: 2016-08-12

By Reuters Staff

NEW YORK (Reuters Health) - Ulcerative proctitis (UP) occurs often in pediatric-onset ulcerative colitis (UC), and does not indicate a less-aggressive course of disease, according to a new study.

"At diagnosis, UP is frequent in paediatric-onset UC and should not be considered a minor disease," Dr. Corinne Gower-Rousseau of the Centre Hospitalier Universitaire Regionale in Lille, France, and colleagues conclude in their report, published online August 3 in Gut.

Little research exists on the natural history of UP, and most studies that have been done took place before the introduction of immunosuppressants (IS) and biologic agents, Dr. Gower-Rousseau and her team state.

To better understand the phenotype and disease course of UP, the researchers looked at data from EPIMAD, a registry that has recorded all incident inflammatory bowel disease cases in northern France since 1988. They identified 158 patients with pediatric-onset UC, 25% of whom had UP at diagnosis.

Median follow-up lasted 11.4 years. Forty-nine percent of the patients with UP had colonic extension at maximal follow-up. Cumulative colonic extension risk was 10% at one year, 45% at five years and 52% at 10 years.

The risk of colonic extension, use of anti-TNF-alpha therapy and colectomy was similar for patients with UP and those initially diagnosed with more widespread disease. However, the UP patients were less likely to receive IS, with 13% of the UP patients receiving them within 10 years of diagnosis compared to 39% of the non-UP patients.

There were no factors significantly associated with the likelihood of colonic extension in the UP group.

"Given the low rate of IS use in our study and these consistent results, it may be hypothesized that patients with UP are undertreated, thereby facilitating the extension of their disease," Dr. Gower-Rousseau and her colleagues state.

"Monitoring of the paediatric patients with UP should be done frequently within 5 years of diagnosis," they add. "It would be very helpful to be able to identify a subgroup of children with UP having a high risk of complications and severe course, in order to start a more aggressive therapeutic management, that is, start earlier IS and/or anti-TNF therapy."

Dr. Gower-Rousseau was not available for an interview by press time.

SOURCE: http://bit.ly/2b2RQDq

Gut 2016.