Consensus Statements Summarize Predictors of Pediatric Ulcerative Colitis Outcomes

The international Pediatric Inflammatory Bowel Disease Ahead Program, also known as PIBD-Ahead, has released more than 2 dozen consensus statements addressing evidence-based predictors of outcomes for children with ulcerative colitis (UC).

“Because treatments for [inflammatory bowel disease (IBD)] have advanced rapidly in recent years, it is important to explore predictors to guide management of the disease,” the authors wrote.

To determine outcomes worthy of prediction, the investigators surveyed 202 experts in pediatric UC from 33 countries. Based on these surveys, the investigators concluded that the most important undesirable outcomes to prevent among children with UC are colectomy, acute severe colitis, chronically active disease, cancer, and mortality. 

The investigators then performed a systematic review with selected meta-analysis to identify predictors of those outcomes. Next, at a series of national and international meetings, evidence-based statements were formulated, validated, and subjected to a final consensus vote. Consensus was considered reached when 80% or more participants voted that they agreed or strongly agreed with the statement.

Participants reached consensus on 31 statements addressing the key undesirable outcomes .

According to the statements, predictors of colectomy include disease extent; Pediatric Ulcerative Colitis Activity Index score; and levels of hemoglobin, hematocrit, and albumin at diagnosis. Over time, family history of UC, extraintestinal manifestations, and disease extension may signal future colectomy. Meanwhile, primary sclerosing cholangitis is considered protective.

Disease severity at onset and hypoalbuminemia are predictors of acute severe colitis, while higher Pediatric Ulcerative Colitis Activity Index score and C-reactive protein level on days 3 and 5 of hospital admission predict intravenous steroid failure, the statements explained.

Concomitant diagnosis of primary sclerosing cholangitis, having colitis for more than 10 years, being a man, and being a younger age at diagnosis are risk factors for cancer.

“[The] consensus statements presented here synthesize the current body of empirical evidence for predictors of pediatric UC outcome with the aim of supporting optimal, personalized treatments for children,” the authors wrote.  

—Jolynn Tumolo

Reference:

Orlanski-Meyer E, Aardoom M, Ricciuto A, et al. Predicting outcomes in pediatric ulcerative colitis for management optimization: systematic review and consensus statements from the Pediatric Inflammatory Bowel Disease-Ahead Program. Gastroenterology. 2021;160(1):378-402.e22. doi:10.1053/j.gastro.2020.07.066