ULCERATIVE-COLITIS IN CHILDREN 10 YEARS OLD OR YOUNGER

The onset and course of ulcerative colitis diagnosed in 38 children at or before 10 years of age were reviewed. The mean age at onset was 5. 9 years. A family history of inflammatory bowel disease was present in 24% of patients, and 13% had a history of cow milk allergy in infancy . Initially, by radiologic or colonoscopic studies, 71% had total colo nic disease, 13% had left-sided colitis, and 6% had proctitis; extensi ve examination was not performed in 4 patients. Four patients (11%) pr esented with severe colitis, 14 (37%) with moderate colitis, and 20 (5 3%) with mild colitis. The most frequent symptoms were abdominal pain (94%), diarrhea (84%), and rectal bleeding (84%). Between 2 and 10 yea rs after diagnosis, 89% of children had total colonic disease and 11% had left-sided disease. All four patients with severe disease at onset responded to medical therapy with one having a colectomy 15 years lat er with pathology consistent with Crohn's disease. Of those with moder ate disease, half had infrequent moderate recurrences and half had int ermittent mild disease. One patient had colectomy at 21 years for intr actable disease. Of the 20 with mild disease, 16 continued to have int ermittent mild recurrences, 1 had chronic mild disease, 2 had moderate recurrent disease, and 1 has remained asymptomatic for 5 years. Psych iatric disturbances requiring therapy were identified in 5 (13%) child ren. Results are encouraging: after the first 2 years of illness, two thirds of the children have had subsequent mild colitis with infrequen t relapses and three quarters consider their life to be of good qualit y.