Journal
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
Volume 55, Issue 3, Pages 340-361Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MPG.0b013e3182662233
Keywords
children; clinical guidelines; European Crohn's and Colitis Organization; European Society for Paediatric Gastroenterology; Hepatology, and Nutrition, management; Pediatric Ulcerative Colitis Activity Index; ulcerative colitis
Funding
- NHS Research Scotland
- Catherine McEwan Foundation
- Yorkhill IBD fund
- MSD
- Abbott
- Dr Falk
- Ferring
- Nestle
- Centocor
- Janssen
- Merck
- Shire
- Janssen Biologics
- Advisory Board for MSD
- Advisory Board for Abbott
- Tillotts AB
- Otsuka Pharma Scandinavia AB
- Schering-Plough AB
- Tillotts Pharma
- Hospital for Sick Children (PUCAI royalties)
- Proctor Gamble
- Johnson Johnson
- Falk
- Biocodex
- Danone
- Falk Foundation
- Meadjohnson
- Medical Research Council [G0800675, G1002033] Funding Source: researchfish
- MRC [G0800675, G1002033] Funding Source: UKRI
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Background and Aims: Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Methods: A group of 27 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to ESPGHAN and ECCO members. A list of 23 predefined questions were addressed by working subgroups based on a SR of the literature. Results: A total of 40 formal recommendations and 68 practice points were endorsed with a consensus rate of at least 89% regarding initial evaluation, how to monitor disease activity, the role of endoscopic evaluation, medical and surgical therapy, timing and choice of each medication, the role of combined therapy, and when to stop medications. A management flowchart, based on the Pediatric Ulcerative Colitis Activity Index (PUCAI), is presented. Conclusions: These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.
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