A recent review of children in the Pediatric Inflammatory Bowel Disease Consortium (PediIBDC) examined risk factors for proctocolectomy in children with Ulcerative Colitis (UC) (JPGN 2012; 55: 534-40). Two of the investigators (Stanley Cohen and Ben Gold) are colleagues of mine at GI Care for Kids.
In total, 406 children with UC were reviewed. The average age at diagnosis was 10.6 years. The average followup was 6.8 years. 57 (14%) underwent surgery with a median time to surgery of 3.8 years. Overall risk factors for colectomy included the following:
- Presenting with weight loss, HR 2.55
- Presenting with hypoalbuminemia (<3.5 g/dL), HR 6.05
- First-degree relative with UC, HR 1.81
- Treatment with cyclosporine, HR 6.11
- Treatment with tacrolimus, HR 3.66
While this data expands on the knowledge of these factors in children, the findings are not unexpected. Low albumin levels and poor nutritional status have been identified in other studies as risk factors for UC relapse and for colectomy.
With regard to first-degree relatives, the findings imply that children with a first-degree relative are more likely to have a more severe form of UC.
The use of calcineurin inhibitors, cyclosporine and tacrolimus, are given only in the presence of severe disease. Thus, while use of these agents is associated with an increased risk of colectomy, it is unlikely that this is a causal relationship. Interestingly, the use of infliximab was not identified as a risk factor. However, this retrospective study examined patients between 1999-2003. Since this timeframe, there has been increased use of infliximab for refractory UC.
Going forward, it is likely that contemporary studies would incorporate PUCAI (pediatric UC activity index) measurements and would have the ability to enroll far greater numbers of patients from database consortiums.
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