Long‐term outcomes of children with ulcerative colitis after acute severe colitis: A GETAID pédiatrique multicenter study

OBJECTIVES: Acute severe colitis (ASC) is a frequent and severe complication of ulcerative colitis (UC) with a high risk of colectomy. Effects of immunosuppressants and anti-tumor necrosis factor (anti-TNF) agents on the risk of colectomy remain debated. We wished to study the evolution of French pediatric-onset UC patients after ASC. METHODS: This retrospective study was conducted in 12 French centers of the GETAID pédiatrique group. Data on patients with UC aged <18 years admitted with ASC (defined as Pediatric Ulcerative Colitis Activity Index [PUCAI] score ≥ 65) between January 2010 and December 2020 were collected at discharge and at 1, 3, and 5 years after admission. The primary outcome was colectomy-free rates at 1 year. Uni- and multivariate analyses were performed to identify prognostic factors associated with the risk of surgery. RESULTS: Of the 102 patients admitted with ASC, 95 (93%) were treated with corticosteroids. Forty-eight (50%) patients were escalated to second-line therapy, mainly to infliximab. Nine patients (8.8%) underwent colectomy before discharge. Colectomy-free survival rates were 82% at 1 year, 76% at 3 years, and 74% at 5 years. Patients without colectomy were in clinical and biological remission for a long time. In multivariate analysis, new onset UC, treatment with azathioprine or anti-TNF agent, were significantly associated with a lower risk of colectomy. CONCLUSIONS: The rate of colectomy decreases but remains high after an episode of acute colitis despite early use of biotherapies. But long-term outcome of pediatric-onset UC patients seems good with sustained clinical and biological remission.