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

Dan Turner*, Frank M. Ruemmele, Esther Orlanski-Meyer, Anne M. Griffiths, Javier Martin De Carpi, Jiri Bronsky, Gabor Veres, Marina Aloi, Caterina Strisciuglio, Christian P. Braegger, Amit Assa, Claudio Romano, Séamus Hussey, Michael Stanton, Mikko Pakarinen, Lissy De Ridder, Konstantinos Katsanos, Nick Croft, Victor Navas-López, David C. WilsonSally Lawrence, Richard K. Russell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

248 Scopus citations

Abstract

Background: The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with 20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of pediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. Methods: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before 2 face-to-face meetings. All 40 included recommendations and 86 practice points were endorsed 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, for more severe disease, biologics. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision-making based on clinical assessment and the Paediatric UC Activity Index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, 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 and IBD-unclassified is also part of these guidelines. Conclusions: These guidelines provide a guide to clinicians managing children with UC and IBD-unclassified management to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

Original languageAmerican English
Pages (from-to)257-291
Number of pages35
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume67
Issue number2
DOIs
StatePublished - 2018

Bibliographical note

Funding Information:
This study was supported by European Crohn’s and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).

Funding Information:
A.A. received research grant from AbbVie. S.H. received a travel bursary from AbbVie. L.d.R. last 3 years received consultation fee, research grant, or honorarium from ZonMw (national health institute), Janssen, Pfizer, Mundipharma, Shire, and Abbvie. K.K. honoraria for consulting services (educational services, scientific articles, participation in Advisory Boards, clinical trials, others) from the companies as follows AbbVie, ENORASIS, Ferring, JANNSEN, MSD, and Takeda. V.N.L. last 3 years received consultation fee or honorarium from Abbvie, Otsuka, and Nestlé Health Science. S.L. last 2 years received honorarium from Janssen. R.K.R. has received speaker’s fees, travel support, or has performed consultancy work with Nestlé Health Science, AbbVie, Napp, Celltrion, Shire, and Janssen. E.O. has received honoraria from Abbvie. N.C. research funding for trials, speaker fees, and travel for conferences from Takeda, Shire, Celgene, and Roche. M.P. lectures and congress fees sponsored by Astellas, Baxter, and Shire. A.M.G. consultancy, speakers fees or research support for Abbvie, Celgene, Ferring, Gilead, Janssen, Pfizer, and Takeda. D.C.W. has received speaker’s fees, travel support, or has performed consultancy work with Abbvie, Takeda, and Falk. M.S., C.S., C.B., and C.R. report no conflicts of interest to declare.

Publisher Copyright:
Copyright © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

Keywords

  • Anti-TNF
  • Calprotectin
  • Children
  • Guidelines
  • Inflammatory bowel disease-unclassified
  • Management
  • Mesalamine
  • Monitoring
  • Pediatric Ulcerative Colitis Activity Index
  • Pediatrics
  • Thiopurines
  • Treatment
  • Ulcerative colitis
  • Vedolizumab

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