Hyams J, Davis P, Lerer T, Colletti R B, Bousvaros A, Leichtner A, Benkov K, Justinich C, Markowitz J
Department of Pediatrics, Hartford Hospital, Connecticut Children's Medical Center, Hartford, USA.
J Pediatr Gastroenterol Nutr. 1997 Aug;25(2):149-52. doi: 10.1097/00005176-199708000-00004.
Although the course of ulcerative proctitis in adults has been well described, little data are available concerning its clinical behavior in children and adolescents. This study sought to characterize the presentation, response to therapy, and long-term course of ulcerative proctitis in the pediatric population.
A retrospective chart review was conducted at five pediatric gastroenterology centers.
A total of 38 subjects (mean age 11.6 years) were identified with ulcerative proctitis (mean follow-up 4.3 years). Symptoms were mild at diagnosis in 74% and moderate or severe in 26%. Thirty-two percent had a complaint of constipation at presentation. Cessation of symptoms was noted in 68% within 3 months of therapy, an additional 24% within 6 months, and 8% were still symptomatic despite 6 months of therapy. During any subsequent yearly follow-up interval, -55% of patients were asymptomatic, 40% had a chronic intermittent course, and < 5% were continuously symptomatic despite therapy. Eight subjects were treated with oral corticosteroids, one with 6-mercaptopurine, and one with cyclosporine. Extension of inflammation proximal to the rectosigmoid occurred in 11 of 38 subjects (29%), 0.5-11.3 years postdiagnosis. Seven of the 13 subjects (54%) followed for > or = 5 years had proximal extension of disease, and two had undergone colectomy.
Despite a mild presentation in most subjects, ulcerative proctitis seems to have a high risk of proximal extension of disease. The overall response to therapy seems to be similar to that reported for ulcerative colitis in children. Follow-up endoscopic evaluation of patients with ulcerative proctitis seems warranted, especially in the setting of recurrent or recalcitrant symptoms.
尽管成人溃疡性直肠炎的病程已有详尽描述，但关于其在儿童和青少年中的临床行为的数据却很少。本研究旨在描述儿童溃疡性直肠炎的临床表现、对治疗的反应及长期病程。
在五个儿科胃肠病中心进行了一项回顾性病历审查。
共确定了38例溃疡性直肠炎患者（平均年龄11.6岁）（平均随访4.3年）。74%的患者诊断时症状较轻，26%为中度或重度。32%的患者就诊时主诉便秘。68%的患者在治疗3个月内症状消失，另外24%在6个月内症状消失，8%的患者尽管治疗6个月仍有症状。在随后的任何一年随访期间，55%的患者无症状，40%有慢性间歇性病程，不到5%的患者尽管接受治疗仍持续有症状。8例患者接受口服皮质类固醇治疗，1例接受6-巯基嘌呤治疗，1例接受环孢素治疗。38例患者中有11例（29%）在诊断后0.5 - 11.3年出现炎症扩展至直肠乙状结肠近端。13例随访≥5年的患者中有7例（54%）疾病近端扩展，2例接受了结肠切除术。
尽管大多数患者表现较轻，但溃疡性直肠炎似乎有较高的疾病近端扩展风险。总体治疗反应似乎与儿童溃疡性结肠炎的报道相似。对溃疡性直肠炎患者进行随访内镜评估似乎是必要的，特别是在出现复发或难治性症状的情况下。
