How Secure is the Diagnosis of Ulcerative Colitis in Children, Even After Colectomy?.

Objectives: We reviewed all children who have undergone a colectomy for ulcerative colitis in our tertiary referral centre in a twelve-year period to assess the rate of reclassification as Crohn's disease. In contrast to Crohn's Disease, a colectomy is considered to be definitive treatment for patients with ulcerative colitis. Distinguishing between the two can be challenging when disease is manifest only within the colon - even histological examination of a colectomy specimen may be inconclusive. Historically, the recognised 'rediagnosis' rate (post colectomy) was reported at around 3-7%. A recent study suggested that a higher rate of 13% should be expected in children. This has implications in terms of pre-operative counselling and surgical decision making. Methods: A retrospective case-note review of all patients who underwent a colectomy for ulcerative colitis between 2003 and 2014 in a single paediatric tertiary referral centre was performed. Results: Of the 570 children diagnosed with inflammatory bowel disease in this period, 190 were diagnosed as ulcerative colitis. Of these 190 cases, 29 underwent a colectomy. None of these was re-classified following histological examination of the colectomy sample. Seven out of the 29 patients (24%) were subsequently diagnosed with Crohn's disease (median follow-up 7.6 years). This is significantly higher than previously reported rates (p = 0.003). Conclusions: Our data suggests that later manifestation of Crohn's disease is more common than previously thought (24%). Therefore, a diagnosis of ulcerative colitis in children should be regarded as provisional and a potential later diagnosis of Crohn's disease taken into account when considering colectomy and J-pouch formation. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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