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Children will have the following common presenting symptoms
- blood loss (84%)
- diarrhoea (74%)
- abdominal pain (62%)
- Weight loss (35%) – less common than in Crohn’s disease (58%)
- other symptoms like lethargy and anorexia (1)
The salient points concerning ulcerative colitis in paediatric patients include:
- commonly presents in childhood
- greater likelihood of distal colitis
- sulphasalazine and aminosalicylates remain the first line alternatives for mild disease and maintenance. Acute steroid therapy is reserved for moderate to severe disease, i.e. growth retardation may be a complication of the disease or steroid therapy. Note that occasionally a use of alternate-day steroids may be effective to reduce the side effects of steroids.
- immunosuppressive agents - these may be used in children with refractory symptoms providing that the child is growing and developing normally and there are no complications.
- colectomy -
- this may be indicated if there are persistent symptoms or failure to grow
- the colectomy rate is around 25% at 5 years if there is moderate to severe disease at diagnosis (1)
Around 90% of children with Ulcerative colitis have pancolitis and half of the children who do not present with pancolitis will rapidly progress to pancolitis (1).
Last reviewed 01/2018