Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition.

Abstract

Background: The contemporary management of ambulatory ulcerativecolitis (UC) continues to be challenging with 20% of children needinga colectomy within childhood years. We thus aimed to standardize dailytreatment of pediatric UC and inflammatory bowel diseases (IBD)-unclas-sified through detailed recommendations and practice points.

Methods: These guidelines are a joint effort of the European Crohn’s andColitis Organization (ECCO) and the Paediatric IBD Porto group of EuropeanSociety of Paediatric Gastroenterology, Hepatology and Nutrition(ESPGHAN). An extensive literature search with subsequent evidenceappraisal using robust methodology was performed before 2 face-to-facemeetings. All 40 included recommendations and 86 practice points wereendorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate.

Results: These guidelines discuss how to optimize the use of mesalamine(including topical), systemic and locally active steroids, thiopurines and, formore severe disease, biologics. The use of other emerging therapies and therole of surgery are also covered. Algorithms are provided to aid therapeuticdecision-making based on clinical assessment and the Paediatric UC ActivityIndex (PUCAI). Advice on contemporary therapeutic targets incorporatingthe use of calprotectin and the role of therapeutic drug monitoring arepresented, as well as other management considerations around pouchitis,extraintestinal manifestations, nutrition, growth, psychology, and transition.A brief section on disease classification using the PIBD-classes criteria andIBD-unclassified is also part of these guidelines.

Conclusions: These guidelines provide a guide to clinicians managing childrenwith UC and IBD-unclassified management to provide modern management stra-tegies while maintaining vigilance around appropriate outcomes and safety issues.