1 - Área de Pediatria, Hospital Dona Estefânia, CHULC;
2 - Unidade de Gastroenterologia Pediátrica, Hospital Dona Estefânia, CHULC
- Poster, XXXVI Reunião Anual da Sociedade Portuguesa de Gastrenterologia, Hepatologia e Nutrição Pediátrica, Porto, 14-15 de março de 2024
- Poster, 56th Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology and Nutricion (ESPGHAN), Milão, 15-18 de maio 2024
RESUMO:
Objectives and Study: To assess the clinical characteristics and management of paediatric ulcerative colitis (UC).
Methods: Longitudinal observational study encompassing all paediatric patients diagnosed with UC between 2019-2022 in a tertiary-care hospital.
Results: We identified 49 patients: 61% male, median age 14 years (IQR 12–15) including two with very early onset (4 and 5 years old). The median time until diagnosis was 3 months (IQR 1-5). Common symptoms at diagnosis included bloody stools (92%), diarrhoea (84%), abdominal pain (65%), weight loss (43%) and fever (18%). Family history of inflammatory bowel disease was present in 10% and 4% had a personal history of autoimmune disease. Extraintestinal manifestations (sclerosing cholangitis and pyoderma gangrenosum) occurred in 4%. The mean PUCAI score at presentation was 40 points (SD 18): 53% mild disease, 35% moderate and in 12% severe. Most patients were E4 (pancolitis, 53%), followed by E2 (left-sided UC, 25%), E3 (extensive disease, 12%) and E1 (proctitis, 4%). Nearly half (45%) were admitted to the hospital. Induction treatment included corticosteroids (63%; 22% IV, 45% oral), mesalazine (43%) and infliximab (IFX) in one case of acute severe colitis. Insufficient response was observed in 5 patients (10%) leading to oral prednisolone (n=2) and admission to IV steroids (n=3). Common drugs for maintenance were mesalazine (86%), azathioprine (67%) and IFX (27%). Indications for starting IFX were steroid-dependency (33%), clinical relapse while corticosteroid tappering (33%) and multiple annual flares (33%). Eighty-seven percent of IFX patients didn’t have severe disease at diagnosis. Other treatment included vedolizumab, ustekinumab, abatacept and tacrolimus. No patient required colectomy. The majority is in clinical (84%) and laboratorial (53%) remission.
Conclusions: In our cohort pancolitis prevailed, as reported in children, yet the majority didn’t have severe disease. Sufficient response to the initial treatment was observed with oral 5-ASAs and systemic steroids being the key in management of new-onset UC patients.