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Management of Severe Pediatric Ulcerative Colitis

Richard K Russell, PhD¹, and Dan Turner, MD, PhD²

Acute, severe ulcerative colitis (ASC) is a more common problem in children compared with adults, explained in part by the more frequent occurrence of an extensive disease phenotype in children. After clarification of the diagnosis, clinical progress during an episode of ASC can be tracked using the Pediatric Ulcerative Colitis Activity Index (PUCAI) score, which helps to guide management on a day-to-day basis and the introduction of second-line therapy where needed. The use of this score provides not only a robust definition of severe disease (PUCAI ≥65) but also provides a threshold for preparation for salvage therapy on day 3 and execution of therapy on day 5 (PUCAI scores of >45 and ≥65, respectively). The choices of medical therapy for steroid resistance are the same as those in adults – either infliximab or a calcineurin inhibitor. Surgery is reserved for non-responders to rescue therapy, or for those who develop toxic megacolon. The increased use of rescue therapy has led to a reduction in colectomy rates in recent years. Inflamm Bowel Dis Monit 2011;11(4):139–44.

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LATEST ARTICLES

Leading Articles
- Management of Severe Pediatric Ulcerative Colitis
  
  Richard K Russell, PhD¹, and Dan Turner, MD, PhD²
  
  ¹Royal Hospital for Sick Children, Glasgow, Scotland, UK, and ²Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
  
  Acute, severe ulcerative colitis (ASC) is a more common problem in children compared with adults, explained in part by the more frequent occurrence of an extensive disease phenotype in children. After clarification of the diagnosis, clinical progress during an episode of ASC can be tracked using the Pediatric Ulcerative Colitis Activity Index (PUCAI) score, which helps to guide management on a day-to-day basis and the introduction of second-line therapy where needed.
- Surgical Management of Stricturing Crohn’s Disease
  
  Alex Tzivanakis MB, BS, BSc, MRCS, and Bruce George, MB, MS, BSc, FRCS
  
  John Radcliffe Hospital, Oxford, UK
  
  About one-third of patients with Crohn’s disease will develop stricturing disease, most of whom will require surgery during their lifetime. Indications and timing of surgery have been changing in recent years with the increased use of biological agents and endoscopic balloon dilatation.
- Diagnosis and Management of Anemia in IBD
  
  Rayko Evstatiev, MD, and Christoph Gasche, MD
  
  Division of Gastroenterology and Hepatology, Department of Medicine III, and Christian Doppler Laboratory on Molecular Cancer Chemoprevention, Medical University of Vienna, Vienna, Austria
  
  With a prevalence of >30%, anemia is the most common extraintestinal complication of IBD. It impacts upon individual wellbeing, physical and mental performance, and, when severe, leads to hospitalization. Still, doctors do not recognize it early, and thus treatment is delayed.
Clinical Reviews
Meeting Reports
- British Society of Gastroenterology Annual Meeting 2011
  
  Paul Henderson, MB ChB, MRCPCH
  
  Department of Child Life and Health, and Gastrointestinal Unit, Centre for Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK
  
  This year’s annual meeting was held at the impressive International Convention Centre, Birmingham, UK. The event was attended by over 2500 people, all keen to receive updates on recent advances in both adult and pediatric gastroenterology through symposia, debates, and poster sessions.

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Produced and published by Remedica Medical Education and Publishing Limited.

May 24, 2012

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