Management of pediatric ulcerative colitis: Joint ECCO and ESPGHAN evidence-based consensus guidelines

Dan Turner*, Arie Levine, Johanna C. Escher, Anne M. Griffiths, Richard K. Russell, Axel Dignass, Jorge Amil Dias, Jiri Bronsky, Christian P. Braegger, Salvatore Cucchiara, Lissy De Ridder, Ulrika L. Fagerberg, Séamus Hussey, Jean Pierre Hugot, Sanja Kolacek, Kaija Leena Kolho, Paolo Lionetti, Anders Pærregaard, Alexander Potapov, Risto RintalaDaniela E. Serban, Annamaria Staiano, Brian Sweeny, Gigi Veerman, Gabor Veres, David C. Wilson, Frank M. Ruemmele

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

328 Scopus citations


Background and Aims: Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Methods: A group of 27 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to ESPGHAN and ECCO members. A list of 23 predefined questions were addressed by working subgroups based on a SR of the literature. Results: A total of 40 formal recommendations and 68 practice points were endorsed with a consensus rate of at least 89% regarding initial evaluation, how to monitor disease activity, the role of endoscopic evaluation, medical and surgical therapy, timing and choice of each medication, the role of combined therapy, and when to stop medications. A management flowchart, based on the Pediatric Ulcerative Colitis Activity Index (PUCAI), is presented. Conclusions: These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.

Original languageAmerican English
Pages (from-to)340-361
Number of pages22
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number3
StatePublished - Sep 2012


  • European Crohn's and Colitis Organization
  • European Society for Paediatric Gastroenterology
  • Hepatology
  • Pediatric Ulcerative Colitis Activity Index
  • and Nutrition
  • children
  • clinical guidelines
  • management
  • ulcerative colitis


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