Dan Turner1, Frank M Ruemmele2, Esther Orlanski-Meyer1, Anne M Griffiths3, Javier Martin de Carpi4, Jiri Bronsky5, Gabor Veres6, Marina Aloi7, Caterina Strisciuglio8, Christian P Braegger9, Amit Assa10, Claudio Romano11, Séamus Hussey12, Michael Stanton13, Mikko Pakarinen14, Lissy de Ridder15, Konstantinos H Katsanos16, Nick Croft17, Víctor Manuel Navas-López18, David C Wilson19, Sally Lawrence20, Richard K Russell21. 1. Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel. 2. Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France. 3. The Hospital for Sick Children, University of Toronto, Toronto, Canada. 4. Hospital Sant Joan de Déu, Barcelona, Spain. 5. Department of Paediatrics, University Hospital Motol, Prague, Czech Republic. 6. Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary. 7. Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome. 8. Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Napoli, Italy. 9. University Children's Hospital, Zurich, Switzerland. 10. Schneider Children's Hospital, Petach Tikva (affiliated to the Sackler Faculty of Medicine), Tel Aviv University, Tel Aviv, Israel. 11. Pediatric Department, University of Messina, Messina, Italy. 12. National Children's Research Centre, Royal College of Surgeons of Ireland and University College Dublin, Ireland. 13. Southampton Children's Hospital, Southampton, UK. 14. Helsinki University Children's Hospital, Department of Pediatric Surgery, Helsinki, Finland. 15. Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 16. Medical School and University Hospital of Ioannina, Ioannina, Greece. 17. Barts and the London School of Medicine, Queen Mary University of London, London, UK. 18. Pediatric Gastroenterology and Nutrition Unit, Hospital Materno, IBIMA, Málaga, Spain. 19. Child Life and Health, University of Edinburgh, Edinburgh, UK. 20. BC Children's Hospital, University of British Columbia, Vancouver BC, Canada. 21. The Royal Hospital for Children, Glasgow, UK.
Abstract
BACKGROUND AND AIM: Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. METHODS: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including 2 face-to-face meetings, was followed by voting of the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts). RESULTS: A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring, and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index. Several topics have been altered since the previous 2011 guidelines and from those published in adults. DISCUSSION: These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.
BACKGROUND AND AIM: Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. METHODS: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including 2 face-to-face meetings, was followed by voting of the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts). RESULTS: A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring, and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index. Several topics have been altered since the previous 2011 guidelines and from those published in adults. DISCUSSION: These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.
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