P-142 Pediatric Ulcerative Colitis in South East Asia -A Milder Phenotype or Treatment Responsive?
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".