Factors predictive of crohn disease following colectomy in medically refractory pediatric colitis

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Abstract

OBJECTIVES: Crohn disease (CD) has been diagnosed following colectomy for ulcerative colitis (UC). This study aims to determine the frequency of this occurrence, and to identify predictive factors leading to a CD diagnosis. MATERIALS AND METHODS: A retrospective chart review was performed in patients who have undergone colectomy. RESULTS: From 1996 to 2006, colectomy was performed in 212 patients, 37 of whom were diagnosed preoperatively with UC. The mean ages at diagnosis and at colectomy were 10.6 ± 4.3 years and 13.7 ± 3.7 years, respectively. Inflammatory bowel disease serology at diagnosis in 29 patients showed that 26 (90%) were pANCA+. Serology was negative in 3. Ten (27%) had nonspecific inflammation of the upper digestive tract. Radiographs in 25 patients indicated no abnormalities in the small intestine. Before colectomy, patients (n = 35) were treated with corticosteroid (97%), 5-ASA (69%), immunomodulator (66%), infliximab (29%), and cyclosporin (11%). The mean postoperative follow-up was 2.6 ± 2 years. Six patients (16%) were found to have CD. All 6 patients were pANCA+ with elevated anti-OmpC (n = 4), ASCA immunoglobulin A (n = 2), and ASCA immunoglobulin G (n = 1). The CD group had higher mean anti-OmpC compared with the UC group, 16.9 ± 5.2 and 6.2 ± 3.4, respectively (P < 0.005). Weight z score at time of surgery was lower in the CD group (-1.38 ± 0.79) than in the UC group (0.29 ± 0.24), P < 0.05. CONCLUSIONS: The possibility of CD remains in a small fraction of patients who undergo colectomy for medically refractory UC. A lower weight and a higher anti-OmpC titer may be predictive of CD.

Original languageEnglish
Pages (from-to)283-286
Number of pages4
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume48
Issue number3
DOIs
StatePublished - Mar 2009

Fingerprint

Colectomy
Colitis
Crohn Disease
Pediatrics
Ulcerative Colitis
Serology
Weights and Measures
Immunologic Factors
Inflammatory Bowel Diseases
Immunoglobulin A
Small Intestine
Gastrointestinal Tract
Adrenal Cortex Hormones
Immunoglobulin G
Inflammation

Keywords

  • Colectomy
  • Crohn disease
  • Indeterminate colitis
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{1ed1665c45e94383999d71b4b0715723,
title = "Factors predictive of crohn disease following colectomy in medically refractory pediatric colitis",
abstract = "OBJECTIVES: Crohn disease (CD) has been diagnosed following colectomy for ulcerative colitis (UC). This study aims to determine the frequency of this occurrence, and to identify predictive factors leading to a CD diagnosis. MATERIALS AND METHODS: A retrospective chart review was performed in patients who have undergone colectomy. RESULTS: From 1996 to 2006, colectomy was performed in 212 patients, 37 of whom were diagnosed preoperatively with UC. The mean ages at diagnosis and at colectomy were 10.6 ± 4.3 years and 13.7 ± 3.7 years, respectively. Inflammatory bowel disease serology at diagnosis in 29 patients showed that 26 (90{\%}) were pANCA+. Serology was negative in 3. Ten (27{\%}) had nonspecific inflammation of the upper digestive tract. Radiographs in 25 patients indicated no abnormalities in the small intestine. Before colectomy, patients (n = 35) were treated with corticosteroid (97{\%}), 5-ASA (69{\%}), immunomodulator (66{\%}), infliximab (29{\%}), and cyclosporin (11{\%}). The mean postoperative follow-up was 2.6 ± 2 years. Six patients (16{\%}) were found to have CD. All 6 patients were pANCA+ with elevated anti-OmpC (n = 4), ASCA immunoglobulin A (n = 2), and ASCA immunoglobulin G (n = 1). The CD group had higher mean anti-OmpC compared with the UC group, 16.9 ± 5.2 and 6.2 ± 3.4, respectively (P < 0.005). Weight z score at time of surgery was lower in the CD group (-1.38 ± 0.79) than in the UC group (0.29 ± 0.24), P < 0.05. CONCLUSIONS: The possibility of CD remains in a small fraction of patients who undergo colectomy for medically refractory UC. A lower weight and a higher anti-OmpC titer may be predictive of CD.",
keywords = "Colectomy, Crohn disease, Indeterminate colitis, Ulcerative colitis",
author = "Evers, {Elisa A.} and Marian Pfefferkorn and Steven Steiner",
year = "2009",
month = "3",
doi = "10.1097/MPG.0b013e318185db01",
language = "English",
volume = "48",
pages = "283--286",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Factors predictive of crohn disease following colectomy in medically refractory pediatric colitis

AU - Evers, Elisa A.

AU - Pfefferkorn, Marian

AU - Steiner, Steven

PY - 2009/3

Y1 - 2009/3

N2 - OBJECTIVES: Crohn disease (CD) has been diagnosed following colectomy for ulcerative colitis (UC). This study aims to determine the frequency of this occurrence, and to identify predictive factors leading to a CD diagnosis. MATERIALS AND METHODS: A retrospective chart review was performed in patients who have undergone colectomy. RESULTS: From 1996 to 2006, colectomy was performed in 212 patients, 37 of whom were diagnosed preoperatively with UC. The mean ages at diagnosis and at colectomy were 10.6 ± 4.3 years and 13.7 ± 3.7 years, respectively. Inflammatory bowel disease serology at diagnosis in 29 patients showed that 26 (90%) were pANCA+. Serology was negative in 3. Ten (27%) had nonspecific inflammation of the upper digestive tract. Radiographs in 25 patients indicated no abnormalities in the small intestine. Before colectomy, patients (n = 35) were treated with corticosteroid (97%), 5-ASA (69%), immunomodulator (66%), infliximab (29%), and cyclosporin (11%). The mean postoperative follow-up was 2.6 ± 2 years. Six patients (16%) were found to have CD. All 6 patients were pANCA+ with elevated anti-OmpC (n = 4), ASCA immunoglobulin A (n = 2), and ASCA immunoglobulin G (n = 1). The CD group had higher mean anti-OmpC compared with the UC group, 16.9 ± 5.2 and 6.2 ± 3.4, respectively (P < 0.005). Weight z score at time of surgery was lower in the CD group (-1.38 ± 0.79) than in the UC group (0.29 ± 0.24), P < 0.05. CONCLUSIONS: The possibility of CD remains in a small fraction of patients who undergo colectomy for medically refractory UC. A lower weight and a higher anti-OmpC titer may be predictive of CD.

AB - OBJECTIVES: Crohn disease (CD) has been diagnosed following colectomy for ulcerative colitis (UC). This study aims to determine the frequency of this occurrence, and to identify predictive factors leading to a CD diagnosis. MATERIALS AND METHODS: A retrospective chart review was performed in patients who have undergone colectomy. RESULTS: From 1996 to 2006, colectomy was performed in 212 patients, 37 of whom were diagnosed preoperatively with UC. The mean ages at diagnosis and at colectomy were 10.6 ± 4.3 years and 13.7 ± 3.7 years, respectively. Inflammatory bowel disease serology at diagnosis in 29 patients showed that 26 (90%) were pANCA+. Serology was negative in 3. Ten (27%) had nonspecific inflammation of the upper digestive tract. Radiographs in 25 patients indicated no abnormalities in the small intestine. Before colectomy, patients (n = 35) were treated with corticosteroid (97%), 5-ASA (69%), immunomodulator (66%), infliximab (29%), and cyclosporin (11%). The mean postoperative follow-up was 2.6 ± 2 years. Six patients (16%) were found to have CD. All 6 patients were pANCA+ with elevated anti-OmpC (n = 4), ASCA immunoglobulin A (n = 2), and ASCA immunoglobulin G (n = 1). The CD group had higher mean anti-OmpC compared with the UC group, 16.9 ± 5.2 and 6.2 ± 3.4, respectively (P < 0.005). Weight z score at time of surgery was lower in the CD group (-1.38 ± 0.79) than in the UC group (0.29 ± 0.24), P < 0.05. CONCLUSIONS: The possibility of CD remains in a small fraction of patients who undergo colectomy for medically refractory UC. A lower weight and a higher anti-OmpC titer may be predictive of CD.

KW - Colectomy

KW - Crohn disease

KW - Indeterminate colitis

KW - Ulcerative colitis

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