P-082: Segmental distribution in refractory ulcerative colitis: a histological evaluation in pediatric and adult patients who underwent proctocolectomy

Uchida, Kôji; Koike, Yukihiro; Hashimoto, Kiyoshi; Otake, Koji; Inoue, Mikihiro; Araki, Tsuyoshi; Okita, Yoshio; Fujikawa, Hiroyuki; Tanaka, Kyosuke; Toiyama, Y.; Inoue, Yasuhiro; Mohri, Yasuhiko; Kusunoki, Masato

doi:10.1016/s1873-9946(14)50104-3

Cited by 2 publications

(3 citation statements)

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“…colonic disease distribution, backwash ileitis, superficial fissures, and even transmural lymphoid aggregates. 24,26,27 Importantly, the typical histopathological findings of CD may be missed if the diagnosis is solely based on mucosal biopsies, underlining the importance of appropriate differential diagnostics. 24 In our sample, patients with later CD diagnosis were more likely to be operated in three stages, reflecting uncertainty of the diagnosis before surgery despite extended diagnostic work-up or a severe phase of the disease.…”

Section: Discussionmentioning

confidence: 99%

Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis

Nyholm

Hukkinen

Koivusalo

et al. 2018

Journal of Crohn's and Colitis

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Background and Aims: Childhood-onset ulcerative colitis [UC] requires total colectomy in onequarter of patients at some point of their disease. The study objective was to evaluate long-term outcomes after proctocolectomy with ileoanal anastomosis [IAA] for paediatric UC. Methods: Medical records of all children undergoing proctocolectomy with IAA for UC during 1985-2016 in Helsinki University Hospital were retrospectively assessed. Data on disease history, diagnostic and operative details, occurrence of surgical complications, functional outcome, postoperative diagnosis of Crohn's disease [CD] and pouch failure were collected. Risk factors for IAA failure were analysed with Cox regression. Results: Of 87 patients, 85 [98%] had UC and 2 [2%] inflammatory bowel disease unclassified [IBD-U] preoperatively. Altogether 66% underwent two-stage and 34% underwent three-stage procedures. During 7.8 [4.1-14.5] years' follow-up, nine [10%] patients were diagnosed with postoperative CD. Postoperative leakages [n = 8, 9%] and strictures [n = 10, 11%] were equally common, whereas fistulas [78% vs 9%, p <0.001] and abscesses [56% vs 14%, p = 0.009] were more frequent among patients with later CD diagnosis. At latest follow-up, eight [9%]patients had been converted to a permanent ileostomy and others reported daytime stooling frequency of 5 [4-7] and 0.5 [0-1] at night. CD diagnosis (hazard ratio [HR] = 23.3, p = 0.005), postoperative abscesses [HR = 16.3, p = 0.013] and fistulas [HR = 20.9, p = 0.007] as well as three-stage surgery [p = 0.018] increased risk for ileostomy.Conclusions: For paediatric UC, long-term surgical and functional outcomes after proctocolectomy with IAA are reassuring. Need for three-stage surgery and occurrence of postoperative fistulas and abscesses, but not leakages or strictures, associate with postoperative CD diagnosis and the risk for ileostomy.

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Section: Discussionmentioning

confidence: 99%

Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis

Nyholm

Hukkinen

Koivusalo

et al. 2018

Journal of Crohn's and Colitis

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“…Uchida et al (9) described the histological segmental distribution of UC in 14 patients with childhood-onset UC (defined as <16 years) (CUC) and 76 with adult-onset UC (AUC) (defined as >16 years) who underwent colectomy. The mean age at surgery for patients with CUC was 19.8 years.…”

Section: Discussionmentioning

confidence: 99%

“…Once UC medical therapy is commenced, it is known to cause patchy inflammation. Multiple studies have described the heterogeneity of degree of rectal inflammation compared with other parts of the resected colon in UC (9,10). It has been suggested that infliximab therapy in UC can result in preferential healing across different parts of the distal colon (11).…”

Section: What Is Newmentioning

confidence: 99%

Precolectomy Therapy Does Not Alter Histologic Findings Distribution in Resected Colon in Pediatric Ulcerative Colitis

Wahbeh

Lawless

Suskind

et al. 2016

J. pediatr. gastroenterol. nutr.

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P-082: Segmental distribution in refractory ulcerative colitis: a histological evaluation in pediatric and adult patients who underwent proctocolectomy

Cited by 2 publications

References 0 publications

Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis

Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis

Precolectomy Therapy Does Not Alter Histologic Findings Distribution in Resected Colon in Pediatric Ulcerative Colitis

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