Nutritional Impact of Medical Management and Surgery in Responsive and Refractory Ulcerative Colitis.
Introduction: With the introduction of new biologics, ulcerative colitis(UC) management in children has changed dramatically in recent years. The aim of this study was to evaluate the impact of biologic therapies and surgery on nutrition in children with UC.
Methods: We performed a retrospective analysis in children (ages 1-19) with UC seen at a pediatric gastroenterology clinic 1/2012-8/2020. We analyzed nutritional parameters over time. Patients were divided into groups: 1)patients treated with non-biologics 2)one biologic 3)two or more biologics, and 4)surgery.
Results: There were 96 patients identified(follow-up: 5.0±3.1 years). Thirty-six were treated with non-biologics, 29 with one biologic, 21 with multiple biologics, and 8 underwent surgery. In groups 2-4, 12 patients delayed changing to biologics for >6 months but their nutrition did not suffer. The mean time to surgery was 2.5 years and patients failed their first biologic at an average of 1.6 years. Albumin was statistically lower in the first year after diagnosis in the surgical group (4.3 vs 3.8 g/dL; p<0.001) foreshadowing their fate. Patients that ultimately underwent surgery trended toward lower mean height, and weight compared to their age groups over the study. BMI improved after surgery (Figure 1, comparing year 1 to year 6; p=0.001). As patients failed a biologic and their regimen was changed, their nutrition persisted at low levels but did not worsen.
Conclusion: The more refractory the UC, the worse the nutritional parameters. Through multiple medical therapies the nutritional status of UC patients is preserved but only surgery changes the trajectory of BMI.
Kumar M, Harvey RN, Fatima A, Osei SK, Menning A, Stallion A, Novotny N. Nutritional impact of medical management and surgery in responsive and refractory ulcerative colitis. Paper presented at: The American College of Surgeons Clinical Congress; 2021 Oct 23-27, 2021; Virtual.