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Predictors of Proctocolectomy in Children With Ulcerative Colitis

Kelley-Quon, Lorraine I.*; Jen, Howard C.*; Ziring, David A.*; Gupta, Neera; Kirschner, Barbara S.§; Ferry, George D.||; Cohen, Stanley A.; Winter, Harland S.#; Heyman, Melvin B.; Gold, Benjamin D.**; Shew, Stephen B.*

Journal of Pediatric Gastroenterology & Nutrition: November 2012 - Volume 55 - Issue 5 - p 534–540
doi: 10.1097/MPG.0b013e3182619d26
Original Articles: Gastroenterology

Objectives: Few clinical predictors are associated with definitive proctocolectomy in children with ulcerative colitis (UC). The purpose of the present study was to identify clinical predictors associated with surgery in children with UC using a disease-specific database.

Methods: Children diagnosed with UC at age <18 years were identified using the Pediatric Inflammatory Bowel Disease Consortium (PediIBDC) database. Demographic and clinical variables from January 1999 to November 2003 were extracted alongside incidence and surgical staging.

Results: Review of the PediIBDC database identified 406 children with UC. Approximately half were girls (51%) with an average age at diagnosis of 10.6 ± 4.4 years in both boys and girls. Average follow-up was 6.8 (±4.0) years. Of the 57 (14%) who underwent surgery, median time to surgery was 3.8 (interquartile range 4.9) years after initial diagnosis. Children presenting with weight loss (hazard ratio [HR] 2.55, 99% confidence interval [CI] 1.21–5.35) or serum albumin <3.5 g/dL (HR 6.05, 99% CI 2.15–17.04) at time of diagnosis and children with a first-degree relative with UC (HR 1.81, 99% CI 1.25–2.61) required earlier surgical intervention. Furthermore, children treated with cyclosporine (HR 6.11, 99% CI 3.90–9.57) or tacrolimus (HR 3.66, 99% CI 1.60–8.39) also required earlier surgical management. Other symptoms, laboratory tests, and medical therapies were not predictive for need of surgery.

Conclusion: Children with UC presenting with hypoalbuminemia, weight loss, a family history of UC, and those treated with calcineurin inhibitors frequently require restorative proctocolectomy for definitive treatment. Early identification and recognition of these factors should be used to shape treatment goals and initiate multidisciplinary care at the time of diagnosis.

*Mattel Children's Hospital

UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA

§The University of Chicago Comer Children's Hospital, Chicago, IL

||Texas Children's Hospital, Baylor College of Medicine, Houston, TX

Children's Center for Digestive Healthcare, Children's Healthcare of Atlanta, Atlanta, GA

#MassGeneral Hospital for Children, Boston, MA

**Emory University School of Medicine, Atlanta, GA.

Address correspondence and reprint requests to Stephen B. Shew, MD, Division of Pediatric Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS Bldg, MC 957098, Los Angeles, CA 90095-7098 (e-mail: sshew@mednet.ucla.edu).

Received 9 February, 2012

Accepted 25 May, 2012

L.K.Q. is a 2010–2012 Robert Wood Johnson Foundation Community Health Leader. M.H. is supported in part by NIH grant DK060617. N.G. is supported in part by NIH grant DK077734. B.K. is supported in part by grants from Abbott and Janssen Biotech. S.C. is supported in part by grants from Given Imaging, Janssen, Abbott, UCB, and Astra Zeneca. H.W. is supported in part by grants from Janssen, UCB Pharma, Nutricia, and Prometheus Labs. B.G. is supported in part by grants from Takeda Pharmaceuticals North America. S.S. is supported in part by NIH grant HD052885. The other authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN