The ACG Governors Award for Excellence in Clinical Research (Fellow-in-Training) and the Presidential Poster Award were presented to a poster presentation on surgical intervention among children with ulcerative colitis (UC).

In the research project, “Children With a History of UC and IPAA Experience a More Rapid Progression to Pouch Failure Compared With Adults and Historical Controls,” presented by Joseph Runde, DO, from the University of Chicago Medicine Inflammatory Bowel Disease Center, Dr Runde and colleagues compared pouch survival outcomes among pediatric patients with those of adults with total proctocolectomy with ileal-pouch anal-anastomosis (IPAA).

The researchers reviewed data from 426 patients who were treated with IPAA for UC and later underwent pouchoscopy at the University of Chicago Medical Center between 1980 and 2019.

The study population was stratified based on age at UC diagnosis or at IPAA, with an upper limit of 19 years of age. The team assessed differences between groups using t-tests and Chi-square tests and compared survival probabilities with Kaplan Meier curves.

The data reviewed resulted in identification of 111 patients under the age of 19 years who were diagnosed with UC and 53 patients who had surgery for IPAA. The researchers found that 18.3% of pediatric patients had pouch failure compared with 9.7% of adult patients. IPAA patients under the age of 19 required anti-tumor necrosis factor (TNF) therapy following their colectomy at a rate of 41.5%, compared with 25.8% of adult patients and 22.0% of pediatric patients with UC who had surgery after age 19 years.

In addition, the researchers found that survival estimates of children who underwent IPAA surgery during the 1990s and first decade of the 2000s remained above 75% until 12 and 25 years postcolectomy. However, pediatric patients whose colectomies were performed since 2010 maintained that 75% survival threshold for only 5 years following surgery.

The study further revealed that pediatric patients treated with IPAA who had received anti-TNF therapy before colectomy showed the most rapid progression to pouch failure than adults or children who were not treated with anti-TNF agents prior to surgery.

“There are lower rates of pouch survival for children with UC undergoing IPAA in the anti-TNF era compared to both historical pediatric controls and contemporary adults,” the researchers noted. “While more work is needed to understand the mechanistic underpinnings associated with these findings, anticipatory guidance for pediatric patient families prior to surgery and plans for surveillance after should reflect these outcomes.”

—Rebecca Mashaw

Reference:

Runde J, Erondu AI, Rai V, Akiyama S, Rubin DT. Children with a history of UC and IPAA experience a more rapid progression to pouch failure compared with adults and historical controls. Talk presented at: American College of Gastroenterology 2020 Clinical Meeting and Postgraduate Course. October 24, 2020. Virtual.