P-142 Pediatric Ulcerative Colitis in South East Asia -A Milder Phenotype or Treatment Responsive?
Notice bibliographique
Résumé
Natural history of Pediatric UC (PUC) in south-east Asian children is not well studied. PUC is considered a more aggressive phenotype compared to adult UC.1,2 Literature also reports high usage of steroids and immunomodulators in PUC. We analyse disease characteristics and response to treatment in PUC in Singapore. Retrospective study on PUC diagnosed < 16 years between 2010 and 2013. We studied disease characteristics and particularly the response to treatment. We excluded patients with co-existing autoimmune liver disease. Twenty-nine patients were included and follow-up ranged between 1 and 3 years. Fifty-nine percent were Male. Age of presentation was between 2 and 15.5 years (median 11.5 years) 9 (31%) presented < 6 years. Montreal classification of extent of UC—E3 (pancolitis) 22 (76%), E2 (left sided) 6 (21%) and E1 (recto-proctitis) 1 (3%). Severity of UC—S1 in 14 (48%), S2 in 13 (45%) and S3 in 2 (7%) TREATMENT At diagnosis, 5-amnosalicylic acids (sulfasalazine or mesalazine) was used in 28/29 patients. 5-ASA was used as single agent in 20 (69%). Prednisolone was used in 8 (27.5%). Immunomodulator was not used. Management of Relapse 5-ASA group (n = 20) 50% who used only 5-ASA relapsed. In this relapsed group, 6 cases had 2 or more relapses and 2 are not in remission (non compliance and other refused Azathioprine). Steroid group (n = 8) 50% (4/8) did not have any relapse. Three cases had 2 or more relapses. Currently all are in remission. Overall steroid usage was 41%. Azathioprine was used in 4 patients. None required surgery. A study on 115 Texas PUC quotes at entry, 25% had E1 localisation, 40% left-sided (E2), and 35% extensive UC (E3) (3). Our figures are 3%, 21% and 76% respectively. However, the Montreal score for severity was 7% for severe disease (S3) and rest were equally classified as S1 and S2. In our study, at diagnosis 69% used high dose 5- ASA as single agent. Steroid was used in combination with 5-ASA in a quarter. The low use of steroid probably reflects milder disease. In the Texas group, 85% received 5-ASA, 60% steroids, 11% received immunomodulator and 4.1% required surgery in the 1st year (3). In another study 79% PUC required steroids in the first year (2). Our experience differs from these with an overall steroid usage in 41% cases. Similarly immunomodulators usage in our cohort during the study period was 14% when compared to 49% in another study (4). Our relapse rate of 50% is comparable to other studies. However, 93% of our cases are currently in remission with low immunomodulator usage. This reinforces that there is little rationale in UC for a top-down approach, where immunomodulators and biologicals are instituted much earlier in the disease course (5). We recommend, use of high dose 5-ASA and aggressive topical 5-ASA therapy before escalating treatment. (1) PUC in South-East Asia seems to be a milder phenotype, (2) Good response to high dose 5-ASA has been noted, (3) Relapse rates are low even with low immunomodulator use.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».