Claudio Romano1, Sana Syed2, Simona Valenti3, Subra Kugathasan2. 1. Inflammatory Bowel Disease Unit, Pediatric Department, University of Messina, Messina, Italy; and romanoc@unime.it. 2. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 3. Inflammatory Bowel Disease Unit, Pediatric Department, University of Messina, Messina, Italy; and.
Abstract
BACKGROUND AND OBJECTIVE: Approximately one-third of children with ulcerative colitis will experience at least 1 attack of acute severe colitis (ASC) before 15 years of age. Severe disease can be defined in children when Pediatric Ulcerative Colitis Activity Index is >65 and/or ≥6 bloody stools per day, and/or 1 of the following: tachycardia, fever, anemia, and elevated erythrocyte sedimentation rate with or without systemic toxicity. Our aim was to provide practical suggestions on the management of ASC in children. The goal of medical therapy is to avoid colectomy while preventing complications of disease, side effects of medications, and mortality. METHODS: A systematic search was carried out through Medline via PubMed to identify all articles published in English to date, based on the following keywords "ulcerative colitis," "pediatric ulcerative colitis," "biological therapy," and "acute severe colitis." Multidisciplinary clinical evaluation is recommended to identify early nonresponders to conventional treatment with intravenous corticosteroids, and to start, if indicated, second-line therapy or "rescue therapy," such as calcineurin inhibitors (cyclosporine, tacrolimus) and anti-tumor necrosis factor molecules (infliximab). RESULTS: Pediatric Ulcerative Colitis Activity Index is a valid predictive tool that can guide clinicians in evaluating response to therapy. Surgery should be considered in the case of complications or rapid clinical deterioration during medical treatment. CONCLUSIONS: Several pitfalls may be present in the management of ASC, and a correct clinical and therapeutic approach is recommended to reduce surgical risk.
BACKGROUND AND OBJECTIVE: Approximately one-third of children with ulcerative colitis will experience at least 1 attack of acute severe colitis (ASC) before 15 years of age. Severe disease can be defined in children when Pediatric Ulcerative Colitis Activity Index is >65 and/or ≥6 bloody stools per day, and/or 1 of the following: tachycardia, fever, anemia, and elevated erythrocyte sedimentation rate with or without systemic toxicity. Our aim was to provide practical suggestions on the management of ASC in children. The goal of medical therapy is to avoid colectomy while preventing complications of disease, side effects of medications, and mortality. METHODS: A systematic search was carried out through Medline via PubMed to identify all articles published in English to date, based on the following keywords "ulcerative colitis," "pediatric ulcerative colitis," "biological therapy," and "acute severe colitis." Multidisciplinary clinical evaluation is recommended to identify early nonresponders to conventional treatment with intravenous corticosteroids, and to start, if indicated, second-line therapy or "rescue therapy," such as calcineurin inhibitors (cyclosporine, tacrolimus) and anti-tumornecrosis factor molecules (infliximab). RESULTS:Pediatric Ulcerative Colitis Activity Index is a valid predictive tool that can guide clinicians in evaluating response to therapy. Surgery should be considered in the case of complications or rapid clinical deterioration during medical treatment. CONCLUSIONS: Several pitfalls may be present in the management of ASC, and a correct clinical and therapeutic approach is recommended to reduce surgical risk.
Authors: Suresh Venkateswaran; Jarod Prince; David J Cutler; Urko M Marigorta; David T Okou; Sampath Prahalad; David Mack; Brendan Boyle; Thomas Walters; Anne Griffiths; Cary G Sauer; Neal LeLeiko; David Keljo; James Markowitz; Susan S Baker; Joel Rosh; Marian Pfefferkorn; Melvin B Heyman; Ashish Patel; Anthony Otley; Robert Baldassano; Joshua Noe; Paul Rufo; Maria Oliva-Hemker; Sonia Davis; Michael E Zwick; Greg Gibson; Lee A Denson; Jeffrey Hyams; Subra Kugathasan Journal: Inflamm Bowel Dis Date: 2018-03-19 Impact factor: 5.325
Authors: J B Wechsler; A Szabo; C L Hsu; R A Krier-Burris; H A Schroeder; M Y Wang; R G Carter; T E Velez; L M Aguiniga; J B Brown; M L Miller; B K Wershil; T A Barrett; P J Bryce Journal: Mucosal Immunol Date: 2018-01-24 Impact factor: 7.313