Inflammatory Bowel Diseases

Skip Navigation LinksHome > January 2011 - Volume 17 - Issue 1 > Acute severe ulcerative colitis in children: A systematic re...
Inflammatory Bowel Diseases:
doi: 10.1002/ibd.21383
Pediatric Review Articles

Acute severe ulcerative colitis in children: A systematic review

Turner, Dan MD, PhD1; Griffiths, Anne M. MD2

Collapse Box


Pediatric ulcerative colitis (UC) has a more severe phenotype, reflected by more extensive disease and a higher rate of acute severe exacerbations. The pooled steroid‐failure rate among 291 children from five studies is 34% (95% confidence interval [CI]: 27%–41%). It is suggested that corticosteroids should be dosed between 1–1.5 mg/kg up to 40–60 mg daily. Food restriction has a limited role in severe UC and should be generally discouraged in children who do not have a surgical abdomen. Appraisal of radiologic findings in children must recognize the variation in colonic width with age and size. Data suggest that the Pediatric UC Activity Index (PUCAI), determined at day 3, should be used to screen for patients likely to fail corticosteroids (>45 points), and at day 5 to dictate the introduction of second‐line therapy (>65–70 points). Cyclosporine is successful in children with severe colitis but its use should be restricted to 3–4 months while bridging to thiopurine treatment (pooled short‐term success rate 81% [95% CI: 76%–86%]; n = 94 from eight studies). Infliximab may be as effective as cyclosporine (75% pooled short‐term response (95% CI: 67%–83%); n = 126, six studies) with a pooled 1‐year response of 64% (95% CI: 56%–72%). In toxic megacolon, in patients refractory to one salvage medical therapy, and in chronic severe disease, colectomy may be preferred. Decision‐making regarding colectomy in children must consider the toxicity of medication consumed over many future years, the quality of life and self‐image associated with either choice, as well as both functional outcomes and, in females, fertility following pouch procedures. (Inflamm Bowel Dis 2011;)

© Crohn's & Colitis Foundation of America, Inc.

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.