Risk of Colectomy in Patients With Pediatric-onset Ulcerative Colitis
Corresponding Author
Firas Rinawi
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Address correspondence and reprint requests to Firas Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, 14 Kaplan St, Petah Tikva, Israel 49202 (e-mail: [email protected]).Search for more papers by this authorAmit Assa
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorRami Eliakim
Sackler Faculty of Medicine, Tel-Aviv University
Department of Gastroenterology, Sheba Medical Center—Tel Hashomer, Tel Aviv
Search for more papers by this authorYael Mozer-Glassberg
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorVered Nachmias-Friedler
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Search for more papers by this authorYaron Niv
Sackler Faculty of Medicine, Tel-Aviv University
Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
Search for more papers by this authorYoram Rosenbach
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Search for more papers by this authorAri Silbermintz
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Search for more papers by this authorNoam Zevit
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorRaanan Shamir
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorCorresponding Author
Firas Rinawi
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Address correspondence and reprint requests to Firas Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, 14 Kaplan St, Petah Tikva, Israel 49202 (e-mail: [email protected]).Search for more papers by this authorAmit Assa
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorRami Eliakim
Sackler Faculty of Medicine, Tel-Aviv University
Department of Gastroenterology, Sheba Medical Center—Tel Hashomer, Tel Aviv
Search for more papers by this authorYael Mozer-Glassberg
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorVered Nachmias-Friedler
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Search for more papers by this authorYaron Niv
Sackler Faculty of Medicine, Tel-Aviv University
Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
Search for more papers by this authorYoram Rosenbach
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Search for more papers by this authorAri Silbermintz
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Search for more papers by this authorNoam Zevit
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorRaanan Shamir
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
Sackler Faculty of Medicine, Tel-Aviv University
Search for more papers by this authorThe authors report no conflicts of interest.
ABSTRACT
Objectives:
Data describing the incidence and risk factors for colectomy in pediatric ulcerative colitis (UC) is inconsistent. Our aim was to describe the colectomy rate and to identify risk factors associated with colectomy in a large cohort of children with UC with long-term follow-up.
Materials and Methods:
We performed a retrospective chart review of pediatric UC cases that were diagnosed at Schneider Children's Medical Center of Israel between 1981 and 2013. Potential predictors for colectomy including age at diagnosis, sex, disease extent, severity indices, and different therapeutic regimens during disease course were assessed.
Results:
Of 188 patients with pediatric onset UC, 34 (18%) underwent colectomy. Median follow-up was 6.9 years (range, 1–30). Kaplan-Meier survival estimates of the cumulative probability for colectomy were 4% at 1 year and 17% at 10 years from diagnosis. Multivariate Cox models showed that male sex (hazard ratio 4.2, P = 0.001) and severe disease at diagnosis reflected by Pediatric Ulcerative Colitis Activity Index score ≥65 (hazard ratio 8.9, P < 0.001) were associated with increased risk for colectomy. Age, disease extent, ethnicity, family history of inflammatory bowel disease, early introduction of immunomodulators, or treatment with antitumor necrosis factor α agent did not affect the risk of colectomy.
Conclusions:
Male sex and higher Pediatric Ulcerative Colitis Activity Index score at diagnosis are independent risk factors for colectomy.
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