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Gastroenterology, hepatology, and nutrition

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L. Howarth, A. Wiskin, D. M. Griffiths, N. A. Afzal, R. M. Beattie.Southampton General Hospital, Southampton, UK

Introduction: Ulcerative colitis (UC) has an incidence of 1.4 per 100 000 in childhood. There is a paucity of data regarding outcome particularly with the increased use of early immunosupression. This is the information families want at diagnosis and needed by clinicians to plan management. This study looks at outcome at 2 years in a cohort with UC referred to a single centre.

Methods: Patients were recruited with a diagnosis made between 2000–03 as a consecutive cohort. All had UC according to standard clinicopathological criteria. Children with Indeterminate colitis were excluded. Follow up data were collected for two years. Assessment was by colitis symptom score, growth, and laboratory parameters. Outcome data were collected on growth, need for Azathioprine, and need for surgery. All patients were treated according to published guidelines.

Results: Thirty two children were recruited. 21 female, 11 male. Mean age 11 (range 2–16). 22 had pan and 10 distal colitis. All were treated with five ASA derivatives and corticosteroids. By 12 months 19/32 and 24 months 24/32 were on Azathioprine for steroid dependant or frequently relapsing disease. None had toxicity from Azathioprine. Growth was well preserved. 2/32 had a colectomy by 12 and 3/32 by 24 months all of whom were steroid dependant from diagnosis and on azathioprine early. Extra intestinal manifestations included thrombosis (1), lung disease (1), osteoporosis (1), liver disease (4) chronic fatigue (3). The only risk factor at diagnosis for the use of azathioprine by 2 years was disease extent (r = 0.478, p = 0.006) confirmed by univariate and multivariate analysis. Colitis symptom score at presentation and age at diagnosis were not predictive

Conclusion: There is a high need for Azathioprine in childhood UC. Colectomy rate at 2 years …

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