Natural history of pediatric-onset ulcerative proctitis is poorly described.
Dr Hochart and colleagues described the phenotype and disease course of incident ulcerative proctitis in a population-based study of pediatric-onset UC.
All patients with UC diagnosed <17 years from 1988 to 2004, and followed during >2 years have been extracted from a population-based registry.
UC location was defined according to the Paris classification.
Cumulative risks for use of immunosuppressants, anti-tumor necrosis factor alpha (TNF-α) therapy, colonic extension and colectomy were described using Kaplan-Meier method.
Risk factors for colonic extension were assessed using Cox proportional hazards models.
|25% had ulcerative proctitis at diagnosis|
The research team observed that 158 patients with pediatric-onset UC with a median age at diagnosis of 15 years have been identified, and followed during a median of 11 years.
Among them, 25% had ulcerative proctitis at diagnosis, and 49% of them presented a colonic extension at maximal follow-up.
In these children, the cumulative risk for colonic extension was 10% at 1 year, 45% at 5 years and 52% at 10 years.
No parameter at diagnosis was associated with colonic extension in the ulcerative proctitis (E1 group).
The research team found that immunosuppressants use was significantly lower in patients with ulcerative proctitis than in those with E2, E3 or E4 location.
For the ulcerative proctitis cohort, the cumulative risk for colectomy was 3% at 1 year, 10% at 5 years, 13% at 10 years and 13% at 15 years.
The researchers noted that the risks for colonic extension, treatment with anti-TNF-α and colectomy did not differ between the E1 group and the E2–E3–E4 group.
Dr Hochart's team concludes, "Ulcerative proctitis is frequent in pediatric-onset UC and should not be considered as a minor disease."
"Compared with more extensive UC locations, risks for colonic extension, anti-TNF-α therapy and colectomy were similar in ulcerative proctitis, whereas the risk for use of IM was lower."