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The Use of 5-Aminosalicylic Acid in Children and Adolescents With Inflammatory Bowel Disease

Sokollik, Christiane, MD*; Fournier, Nicolas, PhD; Rizzuti, David, MSc*; Braegger, Christian P., MD, PhD; Nydegger, Andreas, MD, PhD§; Schibli, Susanne, MD*; Spalinger, Johannes, MD*,∥ the Swiss IBD Cohort Study Group

doi: 10.1097/MCG.0000000000000864
ONLINE ARTICLES: Original Articles
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Background: In ulcerative colitis (UC) 5-aminosalicylic acid (5-ASA) is recommended as primary therapy for mild to moderate disease. Topical 5-ASA has been proven especially effective. In Crohn’s disease (CD) the evidence for a beneficial role of 5-ASA is weak. We investigated the use of topical and systemic 5-ASA therapy in children and adolescents with inflammatory bowel disease.

Materials and Methods: Data of patients younger than 18 years, registered between April 2008 and December 2015 in the Swiss Inflammatory Bowel Disease Cohort, were analyzed.

Results: Three hundred twenty pediatric inflammatory bowel disease patients were included; 189 with CD and 131 with UC. Over one third of UC patients [51 (39%)] received topical 5-ASA therapy and 43 (33%) received combination therapy during their disease course. UC patients with left-sided colitis or proctitis were more likely to receive topical or combination therapy as compared with patients with pancolitis (P<0.001 and <0.001, respectively). An increase in the use of topical 5-ASA therapy in UC patients was noted over time from 5% to 38%. Forty-seven percent of CD patients were treated with oral 5-ASA during their disease course. The usage was stable over time at approximately 15% to 20%.

Conclusions: In recent years a very positive trend showing an increase in topical 5-ASA therapy in children and adolescents with UC has been observed. However topical therapy is still used with relative low frequency, especially in patients with a more extensive disease. Conversely, despite weak evidence supporting 5-ASA use in CD patients it has been frequently prescribed. Physicians should continue to encourage their UC patients to use topical therapy.

*Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital, University of Bern, Bern

Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne

§Division of Pediatric Gastroenterology and Hepatology, University Hospital of Lausanne, Lausanne

Division of Pediatric Gastroenterology and Nutrition and Children’s Research Center, University Children’s Hospital of Zurich, Zurich

Division of Pediatric Gastroenterology, Children’s Hospital of Lucerne, Lucerne, Switzerland

The authors declare that they have nothing to disclose.

Address correspondence to: Christiane Sokollik, MD, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland (e-mail: christiane.sokollik@insel.ch).

Received September 23, 2016

Accepted May 10, 2017

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