PROLONGED MEDICAL THERAPY FOR SEVERE PEDIATRIC ULCERATIVE-COLITIS

Objectives: The optimal timing of surgical intervention for severe ulc erative colitis remains uncertain. Numerous reports recommend surgery within 10-14 days if clinical remission is not achieved, We undertook a study to follow the clinical course and long-term follow-up of patie nts,vith severe ulcerative colitis treated medically for longer than 1 4 days (n = 11). Methods: We performed a retrospective review of all p atients admitted to the hospital with a diagnosis of severe ulcerative colitis who were treated for more than 14 days. Results: Nine percent of patients (n = 1) required surgery during their hospitalization. Ni nety-one percent of patients (n = 10, mean age 8.6 yr, 7 M, 3 F) treat ed with medical and nutritional therapy for more than 14 days went int o clinical remission. Of these, only 10% (n = 1) ultimately required s urgery; 60% remain in clinical remission up to 83 months posthospitali zation (mean follow-up, 49.5 months), whereas 30% suffer from mild to moderate colitis (mean follow-up, 26.3 months). Conclusions: These res ults do not support the recommendation for colectomy for refractory se vere ulcerative colitis if remission is not noted within 2 wk of hospi talization.