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

4 Scopus citations

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 (US)
Pages (from-to)283-286
Number of pages4
JournalJournal of pediatric gastroenterology and nutrition
Volume48
Issue number3
DOIs
StatePublished - Mar 1 2009

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