Characteristics of pediatric ulcerative colitis in Saudi Arabia: a multicenter national study

Abstract

BACKGROUNDDespite the extensive reporting of pediatric ulcerative colitis (UC) from industrialized developed countries, reports from developing countries are limited to small-case series from single centers. The objective of our large multicenter study was to determine the clinical, laboratory, endoscopic characteristics of UC in children from a developing country, Saudi Arabia.DESIGN AND SETTINGSA retrospective study of children diagnosed with UC under the age of 18 years during the period from 2003 to 2012.METHODSPatients enrolled from 15 medical centers from different regions in Saudi Arabia. A unified database collection form specifically designed for this study was completed by all participating centers.RESULTSA total of 188 children were diagnosed with UC during the study period (97 males [51.6%] and 91 females [48.4%]). The mean age at diagnosis was 9.1 years, and the mean duration of symptoms before diagnosis was 8.7 months. Consanguinity was present in 57 cases (32.6%), and the family history of inflammatory bowel disease (IBD) was noted in 16 cases (9%). The most common clinical presentation was blood in stool (90%), followed by diarrhea (86%) and abdominal pain (62%). Laboratory investigations revealed elevated erythrocyte sedimentation rate (82%), anemia (75%), thrombocytosis (72%), and hypoalbuminemia (33%). The extent of the disease was pan colonic in 46.1%, and confined to left side of colon and rectum in 23% and 9.6% of the cases, respectively.CONCLUSIONThis demographically pediatric IBD retrospective study revealed age-related variation in the distribution of IBD. Clinical presentation, with a high prevalence of positive consanguinity and positive family history, was noted in young patients with UC. The data from this study indicate that UC is increasingly recognized in Saudi Arabia and show many similarities to data from North America and Europe.

Pediatric Ulcerative Colitis from Prevalence to Outcome

“…The clinical presentation of UC patients in this study was similar to other studies were bloody diarrhea and abdominal pain are the most common presentations [2,9,11,14,16,17]. For instance, Al-Qabandi, et al [14] reported bloody diarrhea in 94% and abdominal pain in 78% of UC patients.…”

“…In our study, high ESR and CRP was noted in 51% and 57% respectively. This is lower than that reported in Saudi patients (82% and 63% respectively) [16]. Hypoalbuminemia was seen in 47% of patients in this study compared to that reported by AlSaleem, et al [16] which was 33%.…”

“…In contrast to Al-Mofarreh and Al-Mofleh [11] who found male predominance. The presence of family history was 18.5% in this study which is lower than the number reported in Kuwait 31% [14] but higher than the number reported by AlSaleem, et al (9%) [16] who studied 188 patients in Saudi Arabia.…”

“…Ideally, all pediatric patients suspected to have UC should have endoscopic procedure (upper and lower gastrointestinal endoscopy and biopsies) to confirm the diagnosis [21,25]. Most of our patients had pancolitis (81.6%) on colonoscopy which is higher percentage than that reported by Al-Qabandi, et al [14], Docktor, et al [23] and AlSaleem, et al [16] which was 64%, 55% and 46.1% respectively. This might be explained by either the late presentation or the severity of the disease in our population.…”

“…In this study, anemia was noted in 85% of patients. Similarly, AlSaleem, et al [16] reported anemia in 75% but Al-Mofarreh and Al-Mofleh study [11] showed anemia in only 37%. In our study, high ESR and CRP was noted in 51% and 57% respectively.…”