ulcerative colitis in paediatric patients

Last reviewed 01/2018

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).