Predicting the need for colectomy in pediatric patients with ulcerative colitis

Total colectomy is curative for ulcerative colitis. However, many pediatric patients are medically managed and may not require surgery. There are curr ently no available criteria to identify children who will benefit from earl y colectomy. The purpose of this review was to identify criteria associated with the need for colectomy A 15-year review of patients at a major pediat ric center with biopsy-proved ulcerative colitis was conducted. Age at the time of the first symptom, diagnosis, and surgery were recorded as well as steroid dependence, site of disease, extraintestinal manifestations, and fa mily history Seventy-three patients ranging in age from 1 to 18 years were identified. Thirty-seven patients (50.1%) required total colectomy before t he age of 18. The average patient age at the time of the first documented s ymptom was 11.3 +/- 0.5 years. hmong patients who were steroid dependent an d had pan-colitis, 73% required colectomy Patients with these factors faile d medical management 77% (27 of 35) of the time, and colectomy a as perform ed within 3 pears of diagnosis. The combination of steroid dependence and p ancolitis was associated with an increased need for colectomy Ln pediatric patients with these factors, early colectomy may limit the need to endure p rolonged courses of medications and the disability allied with this disease .