Colectomy in pediatric ulcerative colitis: A single center experience of indications, outcomes, and complications

Ashton, James J.; Versteegh, Hendt P.; Batra, Akshay; Afzal, Nadeem; King, Andrew; Griffiths, D.M.; Beattie, R Mark; Stanton, Michael

doi:10.1016/j.jpedsurg.2015.10.077

Cited by 32 publications

(33 citation statements)

References 31 publications

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“…All eligible children (n = 825) were included in the analysis (498 Crohn's disease, 272 ulcerative colitis, 55 IBDU), the mean age at diagnosis was 12.59 years (1.59‐17.64 years), 327 (39.6%) patients were female. The number of patients under paediatric gastroenterology care increased from 198 in 2007 to 343 in 2017, in line with the increase in disease incidence . A summary of the data can be seen in Table .…”

Section: Resultsmentioning

confidence: 89%

“…All patients in Southampton are transitioned by their 18th birthday based on the “Ready, Steady, Go” policy defined locally . Patients attend joint clinic between the age of 17 and 18 years and it is not possible to list the precise age for transition of individual patients. Patients reaching the age of 18 years being removed from the analysis for the following year. The number of patients in paediatric care in our service in 2007 n = 198) and the number of patients diagnosed for each subsequent year (Table ) …”

Section: Methodsmentioning

confidence: 99%

“…17,18 In contrast to the increasing incidence of disease, the rates of paediatric surgery have not been reported to change over time. 19,20 The impact of increasing use of anti-TNF therapy on surgical procedure rates during childhood is important to guide use of these medications and understand prognoses for patients and families. In this study, we looked at surgical and anti-TNF data in the context of disease incidence and prevalence, over an 11-year period.…”

Section: Introductionmentioning

confidence: 99%

“…The number of patients in paediatric care in our service in 2007 n = 198) and the number of patients diagnosed for each subsequent year (Table 1). 19 From these data, the annual prevalence of anti-TNF-treated the increase in disease incidence. 19 A summary of the data can be seen in Table 1.…”

mentioning

confidence: 99%

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Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

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Summary Background Anti‐tumour necrosis factor‐α (anti‐TNF) therapy use has risen in paediatric‐onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti‐TNF‐therapy and surgery. Aim To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti‐TNF‐therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact). Results Eight‐hundred‐and‐twenty‐five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD‐unclassified), mean age at diagnosis 13.6 years (1.6‐17.6), 39.6% female. The prevalence of anti‐TNF‐treated patients increased from 5.1% to 27.1% (2007‐2017), P = 0.0001. Surgical resection‐rate fell (7.1%‐1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%‐2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection‐rates were unchanged. Time from diagnosis to resection increased (1.6‐2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007‐2011 = 13.1 years, 2013‐2017 = 11.9 years, P = 0.014). Resection‐rate in anti‐TNF‐therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti‐TNF‐therapy <3 years post‐diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti‐TNF‐therapy prevalence was the only significant predictor of resection‐rate using multivariate regression (P = 0.011). Conclusions The prevalence of anti‐TNF‐therapy increased significantly, alongside a decrease in surgical resection‐rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti‐TNF‐therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.

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Section: Resultsmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

Self Cite

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“…85 Between 8% and 26% of children with ulcerative colitis will need a colectomy in the first five years from diagnosis. [115][116][117] Postoperative complications tend to be more common in children who have emergent colectomy compared with elective colectomy (n=30, retrospective review). 118 The post-colectomy general health status and overall QOL in pediatric onset ulcerative colitis was found to be comparable to the that of normal population (n=52, controls=117; questionnaire survey).…”

Section: Surgerymentioning

confidence: 99%

Diagnosis and management of inflammatory bowel disease in children

Oliveira

Monteiro

2017

BMJ

123

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Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are lifelong conditions that often begin in childhood. The implications of IBD are of particular importance in children because of the potential negative effects on growth, development, psychosocial function, and overall wellbeing. The key management strategy is to achieve sustained control of intestinal inflammation and monitor for potential complications of the disease and side effects of therapies. Overall, the evidence on the management of IBD in children is less extensive than in adults, but good quality multicenter studies and various guidelines and society consensus statements are available. This review summarizes the evidence on the pathophysiology, diagnosis, and approaches to management of children and adolescents with IBD.

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Natural History of Ulcerative Colitis in Children

Townsend¹,

Hyams²

2017

Pediatric Inflammatory Bowel Disease

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Colectomy in pediatric ulcerative colitis: A single center experience of indications, outcomes, and complications

Cited by 32 publications

References 31 publications

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Diagnosis and management of inflammatory bowel disease in children

Natural History of Ulcerative Colitis in Children

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