How Secure Is the Diagnosis of Ulcerative Colitis in Children, Even After Colectomy?

Conclusions:Our data suggest that later manifestation of CD is more common than previously thought (24%). Therefore, a diagnosis of UC in children should be regarded as provisional and a potential later diagnosis of CD taken into account when considering colectomy and J-pouch formation. Objectives: We reviewed all children who have undergone a colectomy for ulcerative colitis (UC) in our tertiary referral centre in a 12-year period to assess the rate of reclassification as Crohn disease (CD). In contrast to CD, a colectomy is considered to be definitive treatment for patients with UC. Distinguishing between the 2 can be challenging when disease is manifest only within the colon—even histological examination of a colectomy specimen may be inconclusive. Historically, the recognised “rediagnosis” rate (post-colectomy) was reported at approximately 3% to 7%. A recent study suggested that a higher rate of 13% should be expected in children. This has implications in terms of pre-operative counselling and surgical decision making. Methods: A retrospective case-note review of all patients who underwent a colectomy for UC between 2003 and 2014 in a single paediatric tertiary referral centre was performed. Results: Of the 570 children diagnosed with inflammatory bowel disease in this period, 190 were diagnosed as UC. Of these 190 cases, 29 underwent a colectomy. None of these was re-classified following histological examination of the colectomy sample. Seven out of the ...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Gastroenterology: Inflammatory Bowel Disease Source Type: research