P315 The characteristics and severity of pediatric ulcerative proctitis
Müller, K.(1)*;Dohos , D.(2);Imrei, M.(3);Gombos, E.(3);Szentannay , J.(3);Szabó, A.(3);Oberfrank, M.(4);Karoliny, A.(5);
(1)Heim Pal National Institute for Pediatrics, Gastroenterology and Nephrology, Budapest, Hungary;(2)Heim Pal Nationap Pediatric Institute, Gastroenterology and Nephrology, Budapest, Hungary;(3)Heim Pal National Pediatric Institute, Gastroenterology and Nephrology, Budapest, Hungary;(4)Heim Pál National Pediatric Institute, Gastroenterology and Nephrology, Budapest, Hungary;(5)Heim Pal National Peditric Institute, Gastroenterology and nephrology, Budapest, Hungary;
Background
The diagnosis of ulcerative proctitis is rarer in childhood than in adulthood (4-29% vs. 44-60%). According to the literature, the prognosis of ulcerative colitis is favourable, however one third of the patients require biological therapy during follow-up, and the localization may extend in 20-25% in 5 years. Our aim was to compare the disease characteristics at diagnosis in children with ulcerative proctitis and with more extensive ulcerative colitis.
Methods
Retrospective, single centre analyses of patients with ulcerative colitis, diagnosed between 2010-2022 at the Heim Pál National Paediatric Institute, Budapest, Hungary. We compared the initial demographic, anthropometric data, and laboratory parameters of children with ulcerative proctitis (E1) and more extensive ulcerative colitis (E2-E4) according to the Paris classification. The analyses were performed with descriptive statistics and 2 samples t-tests.
Results
Between 2010-2022, of the 127 children were diagnosed with ulcerative colitis, 22 had proctitis (17.3%; 10 male; mean age: 15.0±1.9 year) and 105 had more extensive disease (82.7%; 53 boy; mean age: 12.2±3.8 year). The mean age was significantly higher in the proctitis group. The initial CRP, platelet count and faecal calprotectin (FCP) level was significantly lower (CRP [mg/l]: 1.2±1.4 vs. 12.0±21.5, p<0.001; thrombocyte [G/l]: 264.9±611.9 vs. 420.6±183.7, p<0.001; FCP [μg/mg]: 416.5±411.4 vs. 1054.5±316.6, p=0.001); while the haematocrit and albumin level was significantly higher (haematocrit [%]: 38.6±3.1 vs. 33.6±5.2, p<0.001; albumin [g/l]: 46.6±2.9 vs. 42.7±4.4, p<0.001) in the proctitis group compared to the other group. BMI z-score value at diagnosis was significantly higher in the proctitis group (0.45±1.4 vs. -0.12±1.2, p=0.02). The initial activity index (PUCAI) was significantly higher in the more extensive group (at diagnosis: 25.0±11.0 vs. 45.1±18.9, p<0.01).
Conclusion
Our results are in line with the literature, that the proportion of ulcerative proctitis is low in children. Based on our results, the manifestation of ulcerative proctitis presents in a milder form than more extensive colitis. Though it is important, that physicians should always consider the extension of the disease and need for treatment escalation to reach mucosal healing.