Background: Children with acute severe ulcerative colitis (ASC) often require hospitalization. Colectomy is needed for medically intractable disease. Patients often undergo endoscopy to exclude opportunistic infections and assess disease severity and extent. There is limited knowledge about the utility of endoscopic and histologic disease severity scores predicting progression to colectomy. Aim: Assess the association between endoscopic and histologic disease severity and colectomy in pediatric ASC. Methods: Retrospective review for UC patients <18 years hospitalized at Seattle Children’s Sep 2015- June 2017. Inclusion criteria were UC and colonoscopy during or within 8 weeks of hospitalization. Endoscopic Mayo score was assigned. A pathologist, blinded to patients’ clinical outcome, reviewed biopsies and assigned a Geboes histologic scores (based on 7 defined parameters). Data analysis was based on the highest Mayo and histologic scores for each patient. We used chi-squared analysis for binary data; and two-sample t-test and Wilcoxon rank-sum for parametric and non-parametric data to assess the association between endoscopic and histologic scores and colectomy. Results: 27 patients (11 m, 16 f) met inclusion criteria with complete data. 10/27 patients underwent colectomy after ASC presentation. Two findings showed statistically significant association with colectomy: histologic ulceration (P=0.024) and lymphoplasmacytic infiltrate (P=0.038). None of the remaining variables including age, gender, Mayo score, histologic structural abnormalities inflammatory infiltrates showed correlation with need for colectomy. Sample size may have limited our ability to show further correlations. Conclusion: The presence of histologic ulceration and increased lymphoplasmacytic infiltrate were significantly correlated with need for colectomy. A larger study may show further relevant associations and provide a clinically helpful predictive model.
