Limited data are available on the natural history of pediatric ulcerative colitis (UC) in Eastern Asia. Our aim was to report the presentation and progression of patients diagnosed with UC during childhood in KoreaMethods:
We reviewed medical records for all 211 patients diagnosed in the period 1988 to 2013 with childhood onset UC in Asan Medical Center, Seoul, South Korea. We investigated the demographic data, disease locations, therapeutic modalities, rate of relapse, colectomy, and cancer at maximal follow up.Results:
Mean age at diagnosis is 13.1 ± 3.3 years. The male:female ratio was 123:97 and median follow up time was 6.5 years (0.3–29.3). Extraintestinal symptoms were experienced by 15.9% (35/220) of the children. Family history was present in 11.4% (25/220). At diagnosis, 28.6% (N = 63) of patients had proctitis (E1), 24.5% (N = 54) left-sided colitis (E2), and 38.7% (N = 86) extensive colitis (E3). At diagnosis, 95.2% of patients received 5-aminosalicyclic acid, and 41.2% received steroids. During follow-up, 34.5% received an immunomodulator, and 10.9% received anti-tumor necrosis factor agents. Twenty-six E1 localizations progressed to E2 (11/63, 17.5%) and E3 (15/63, 23.8%). Nineteen E2 localizations (19/54, 35.2%) progressed to extensive colitis (E3). The cumulative relapse rate after 1, 5, 10, and 15 years was 32.1%, 54.1%, 62.3%, and 72.9%, respectively. Total 18 patients had colectomy and 3 patients had colon cancer. The cumulative rate of colectomy was 1.4% after 2 years, 2.4% after 5 years, 8.8% after 10 years and 15.3% after 20 years. The cumulative risk of colon cancer was 0% after 10 years, 2% after 15 years, and 12.0% after 20 years. E3 disease location at diagnosis (OR 3.459: 95% CI, 1.246–9.603, P = 0.017) and use of systemic corticosteroid therapy (OR 8.437: 1.099–64.753, P = 0.04) are the significant risk factors of colectomy. Primary sclerosing cholangitis (N = 12, 5.5%) is highly related with colon cancer (OR 8.638: 95% CI, 3.457–495.814).Conclusions:
The disease extent of Korean children with UC at diagnosis is similar to those of Western children. However, UC in Korean children may have a milder course than in Westerners, as indicated by the lower rate of colectomy and disease extension.