The natural history of pediatric ulcerative colitis: a population-based cohort study.
OBJECTIVE
The natural history of ulcerative colitis (UC) has been poorly described in children.


METHODS
In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 113 UC patients (age 0-17 years at diagnosis) with a follow-up of at least 2 years. The cumulative risk of colectomy was estimated by the Kaplan-Meier method. Risk factors for disease extension were assessed with logistic regression models, and risk factors for colectomy with Cox hazards proportional models.


RESULTS
Median follow-up time was 77 months (46-125). At diagnosis, 28% of patients had proctitis, 35% left-sided colitis, and 37% extensive colitis. Disease course was characterized by disease extension in 49% of patients. A delay in diagnosis of more than 6 months and a family history of inflammatory bowel disease were associated with an increased risk of disease extension, with odds ratios of 5.0 (1.2-21.5) and 11.8 (1.3-111.3), respectively. The cumulative rate of colectomy was 8% at 1 year, 15% at 3 years, and 20% at 5 years. The presence of extra-intestinal manifestations (EIMS) at diagnosis was associated with an increased risk of colectomy (hazard ratio (HR)=3.5 (1.2-10.5)). Among the patients with limited disease at diagnosis, the risk of colectomy was higher in those who experienced disease extension than in those who did not (HR=13.3 1.7-101.7).


CONCLUSIONS
Pediatric UC was characterized by widespread localization at diagnosis and a high rate of disease extension. Twenty percent of children had their colon removed after 5 years. The colectomy rate was influenced by disease extension and was associated with the presence of EIMS at diagnosis.
Registre des Maladies inflammatoires chroniques de l'Intestin du Nord Ouest de la France Pôle de Santé Publique CHRU, EA2694-Université de Lille 2, France.
Corinne
C
Gower-Rousseau
Luc
L
Dauchet
Gwénola
G
Vernier-Massouille
Emmanuelle
E
Tilloy
Franck
F
Brazier
Véronique
V
Merle
Jean-Louis
JL
Dupas
Guillaume
G
Savoye
Mamadou
M
Baldé
Raymond
R
Marti
Eric
E
Lerebours
Antoine
A
Cortot
Jean-Louis
JL
Salomez
Dominique
D
Turck
Jean-Frédéric
JF
Colombel
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000150:complications / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male