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Managing paediatric acute severe ulcerative colitis according to the 2011 ECCO-ESPGHAN guidelines: Efficacy of infliximab as a rescue therapy.
- Source :
-
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2015 Jun; Vol. 47 (6), pp. 455-9. Date of Electronic Publication: 2015 Feb 04. - Publication Year :
- 2015
-
Abstract
- Background: The effectiveness of medical therapy in paediatric acute severe colitis is scarcely described. We aimed to assess the efficacy of infliximab in children prospectively enrolled at Sapienza University of Rome between May 2010 and 2012.<br />Methods: Clinical assessment and laboratory data were recorded at admission and at day 3 and 5. All patients received corticosteroids; infliximab was administered in refractory patients. Colectomy rate was assessed at 2-year follow-up.<br />Results: Thirty-one patients (mean age 10.6±4.9 years, 52% females) were included: 21 responded to corticosteroids (68%), 10 were refractory and received infliximab (32%). Among the latter, 2 required urgent colectomy (20%); 80% responded, however 50% of these required elective colectomy during follow-up. Patients refractory to corticosteroids showed a significantly shorter interval from ulcerative colitis diagnosis to acute severe colitis compared to responders (7.4±9.6 vs. 23.1±21.6 months, respectively; p=0.01), and a higher rate of colectomy at follow-up (50% vs. 14%, respectively; p=0.007). More than 2 courses of corticosteroids before acute severe colitis were predictive of surgical need (OR 4.4).<br />Conclusion: Despite its short-term efficacy, infliximab did not modify the long-term surgical rate of paediatric acute severe colitis in our cohort. Children with an early severe colitis commonly need a second-line therapy, whilst frequent courses of corticosteroids are predictive of a poor outcome.<br /> (Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Subjects :
- Adolescent
Child
Colitis, Ulcerative surgery
Female
Follow-Up Studies
Humans
Male
Practice Guidelines as Topic
Prospective Studies
Severity of Illness Index
Treatment Failure
Treatment Outcome
Adrenal Cortex Hormones therapeutic use
Anti-Inflammatory Agents therapeutic use
Colectomy statistics & numerical data
Colitis, Ulcerative drug therapy
Gastrointestinal Agents therapeutic use
Infliximab therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1878-3562
- Volume :
- 47
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
- Publication Type :
- Academic Journal
- Accession number :
- 25733340
- Full Text :
- https://doi.org/10.1016/j.dld.2015.01.156