Ulcerative colitis in paediatric patients

Children will have the following common presenting symptoms

• blood loss (84%)
• diarrhoea (74%)
• abdominal pain (62%)
• Weight loss (35%) – less common than in Crohn’s disease (58%)
• other symptoms like lethargy and anorexia (1)

The salient points concerning ulcerative colitis in paediatric patients include:

• commonly presents in childhood
• greater likelihood of distal colitis
• sulphasalazine and aminosalicylates remain the first line alternatives for mild disease and maintenance. Acute steroid therapy is reserved for moderate to severe disease, i.e. growth retardation may be a complication of the disease or steroid therapy. Note that occasionally a use of alternate-day steroids may be effective to reduce the side effects of steroids.
• immunosuppressive agents - these may be used in children with refractory symptoms providing that the child is growing and developing normally and there are no complications.
• colectomy -
  • this may be indicated if there are persistent symptoms or failure to grow
  • the colectomy rate is around 25% at 5 years if there is moderate to severe disease at diagnosis (1)

Around 90% of children with Ulcerative colitis have pancolitis and half of the children who do not present with pancolitis will rapidly progress to pancolitis (1).

Reference:

• (1) British Society of Paediatrics Gastroenterology Hepatology and Nutrition (BSPGHAN) 2008. Guidelines for the Management of Inflammatory Bowel Disease (IBD) in Children in the United Kingdom