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Acute severe ulcerative colitis in children: A systematic review

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

doi: 10.1002/ibd.21383
Pediatric Review Articles

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;)

1Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel

2Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Ontario, Canada

Reprints: Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem 91031, Israel

Email: turnerd@szmc.org.il

Received 11 May 2010; Accepted 12 May 2010

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