{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T19:55:58Z","timestamp":1778010958269,"version":"3.51.4"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although ulcerative proctitis (UP) in children is considered relatively mild, some patients have proximal disease extension and require immunosuppressive treatment. We investigated clinical characteristics and course of refractory UP in a multicenter pediatric cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Analyzing data obtained between 2013 and 2022 at 10 institutions specializing in pediatric inflammatory bowel disease, we elucidated natural history and factors predicting a need for immunosuppressive UP treatment. We compared patients given immunosuppressants and\/or biologic agents (immunosuppressive treatment group) with those given 5-aminosalicylic acid (5-ASA) alone (5-ASA group).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fifty-five patients were followed for 3.5 years. The median Pediatric Ulcerative Colitis Activity Index at diagnosis was 20. The commonest treatment, 5-ASA suppository monotherapy in 40% of patients, showed the worst compliance. Clinical remission was achieved at least once in 95% of all patients. Disease extension beyond the splenic flexure occurred in 51%. Immunosuppressive treatment was given to 37%; biologic agents were used for 18%. Rates of endoscopically demonstrated inflammation, including Ra\/Rs at diagnosis and extension beyond the left-sided colon, were higher in the immunosuppressive treatment group (70% vs 38%, P\u2005&amp;lt;\u20050.05; 95% vs 27%, P\u2005&amp;lt;\u20050.0001). The log-rank test and multivariate Cox proportional hazards regression showed that time to first clinical remission exceeding 3 months predicted the need for biologics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The typical initial treatment of pediatric UP was 5-ASA suppositories, despite poor compliance. Biologics or other immunosuppressive treatments were needed in 37% of patients. Close follow-up with adjustment of treatment should be considered in children with UP as its clinical course varies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ibd\/izae266","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T18:11:55Z","timestamp":1732039915000},"page":"1902-1909","source":"Crossref","is-referenced-by-count":2,"title":["Long-Term Course and Prognostic Factors in Pediatric Ulcerative Proctitis: A Multicenter Cohort Study"],"prefix":"10.1093","volume":"31","author":[{"given":"Ayako","family":"Miyazawa","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Saitama Children\u2019s Medical Center , 1-2, Shintoshin, Chuo-ku, Saitama City, Saitama 330-8777 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University Faculty of Medicine , 3-1-3, Hongo, Bunkyo City, Tokyo 113-0033 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Nishizawa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Gunma University Graduate School of Medicine , 3-39-15, Showamachi, Maebashi, Gunma 371-8511 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Jichi Medical University , 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0431 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin-Ichiro","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women\u2019s and Children\u2019s Hospital , 840, Murodocho, Izumi, Osaka 594-1101 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiri","family":"Kaji","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Osaka Medical and Pharmaceutical University , 2-7, Daigakumachi, Takatsuki, Osaka 569-0801 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuki","family":"Mizuochi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Kurume University School of Medicine , 67, Asahimachi, Kurume, Fukuoka 830-0011 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Kurasawa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Shinshu University School of Medicine , 3-1-1, Asahi, Matsumoto, Nagano 390-0802 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiko","family":"Kakuta","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics and Gastroenterology, Miyagi Children\u2019s Hospital , 4-3-17, Ochiai, Aoba Ward, Sendai, Miyagi 989-3126 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ishige","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Gunma University Graduate School of Medicine , 3-39-15, Showamachi, Maebashi, Gunma 371-8511 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Juntendo University Faculty of Medicine , 3-1-3, Hongo, Bunkyo City, Tokyo 113-0033 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8677-8195","authenticated-orcid":false,"given":"Itaru","family":"Iwama","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Saitama Children\u2019s Medical Center , 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