TBA (19W143)

Familial, Environmental And Clinical Factors Affecting Progression To Colectomy In Children With Severe Ulcerative Colitis

Author(s)

S. Cooper1,2, I. Csizmadia1,2, L.P. Ekpotu1,2,3, K. O'Driscoll2, M. O'Connell2, J. Quinlan2, S. Kiernan2, M. McDermott4, M. O’Sullivan4, S. Quinn2, A. Broderick1,2,5, B. Bourke1,2,5, S. Hussey1,2,3,5, on behalf of the DOCHAS Study 1,2,3,5

Department(s)/Institutions

1 Children's Clinical Research Unit, National Children's Research Centre, Children's Health Ireland at Crumlin, Dublin, Ireland, 2 Department of Gastroenterology, Hepatology and Nutrition, Children's Health Ireland at Crumlin, Dublin, Ireland, 3 Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland, 4 Department of Histopathology, Children's Health Ireland at Crumlin, Dublin, Ireland. 5 Department of Paediatrics, University College Dublin, Dublin, Ireland,

Introduction

The incidence of paediatric inflammatory bowel disease (PIBD) including ulcerative colitis (UC) has increased significantly in Ireland over the last 20 years. A subset of children with ever severe (S1) UC will fail to respond to medical management and ultimately progress to colectomy. The reasons for this remain largely unknown.

Aims/Background

The aim of this study was to probe for risk factors for progressing to colectomy in children with S1 UC.

Method

Patients under investigation for PIBD were recruited to the DOCHAS (Determinants and Outcomes in Children and Adolescents with Inflammatory Bowel Disease) study in CHI at Crumlin between January 2012 and August 2018. Familial, environmental and clinical features at diagnosis were compared between patients with severe UC who progressed to colectomy versus those who were medically managed. Independent categorical variables were compared using Chi-squared analysis.

Results

830 patients were recruited, 85 (10.2%) of these were diagnosed with UC with a S1 phenotype of which 74 (87.1%, 39M) were managed medically and 11 (12.9%, 4M) progressed to colectomy. Urban dwelling (90.9% vs 47.3%, p= .009) and NSAID use (81.8% vs 52.7%, p= .04) was significantly higher in the colectomy versus medically managed group. Although significance was not reached, breastfeeding rates were lower in the colectomy versus medically managed group (36.4% vs 45.9%). No association was seen with age at diagnosis, gender, disease extent, family history of IBD or autoimmune disease, caesarean section delivery or smoking exposure.

Conclusions

Further examination of urban dwelling and NSAID effects is warranted. A larger population may yield more significant information on the impact of breastfeeding.