Faculty Collaboration Database

Abdominal X-ray in Pediatric Acute Severe Colitis and Radiographic Predictors of Response to Intravenous Steroids. J Pediatr Gastroenterol Nutr 2016 Feb;62(2):259-63

Date

07/22/2015

Pubmed ID

26196204

DOI

10.1097/MPG.0000000000000910

Scopus ID

2-s2.0-84957077809 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: Abdominal x-ray (AXR) can identify complications in acute severe colitis (ASC) and may assist in selecting high-risk children for early aggressive treatment. We aimed to describe AXR findings in pediatric ASC and to explore radiological predictors of response to intravenous corticosteroid (IVCS) therapy.

METHODS: A total of 56 children with ASC were included in a multicenter, retrospective 1-year cohort study (41% boys, mean age 12.1 ± 4.2). Radiographs of responders to IVCS and those requiring second-line salvage therapy by discharge were analyzed independently by 2 blinded radiologists.

RESULTS: A total of 33 responders to IVCS were compared with 23 nonresponders. The day-3 Pediatric Ulcerative Colitis Activity Index (PUCAI) score was significantly higher in nonresponders (63 ± 16 vs 46 ± 21, P = 0.001). The mean transverse colon luminal diameter was 30 ± 16 mm in responders and 38 ± 16 mm in nonresponders (P = 0.94). The upper range of transverse colonic diameter in children <12 years was ∼40 mm, whereas in older children it was 60 mm as accepted in adults. Ulcerations and megacolon seen on AXR were associated with nonresponse to IVCS (P = 0.006 and 0.064, respectively).

CONCLUSIONS: The presence of mucosal ulcerations and megacolon on AXR could be considered in the risk stratification of children with ASC for early aggressive treatment, together with the previously known day-3 and day-5 Pediatric Ulcerative Colitis Activity Index scores, albumin, and C-reactive protein.

Author List

Livshits A, Fisher D, Hadas I, Bdolah-Abram T, Mack D, Hyams J, Crandall W, Griffiths AM, Turner D

Author

Alina Tvina MD Adjunct Instructor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adrenal Cortex Hormones
Albumins
C-Reactive Protein
Child
Colitis
Colitis, Ulcerative
Colon
Colon, Transverse
Female
Humans
Intestinal Mucosa
Male
Megacolon
Radiography, Abdominal
Retrospective Studies
Severity of Illness Index
Treatment Outcome
X-Rays