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Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care- an Evidence-Based Guideline from ECCO and ESPGHAN

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

Journal of Pediatric Gastroenterology and Nutrition: May 30, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002035
Societal Paper: PDF Only

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 paediatric 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 two 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 centre on initial use of mesalamine (including topical), before using steroids, thiopurines and, for more severe disease, anti-TNF. 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 IBDU is also part of these guidelines.

Conclusion: These guidelines provide a guide to clinicians managing children with UC and IBDU to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

*Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel

Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France

The Hospital for Sick Children, University of Toronto, Canada

§Hospital Sant Joan de Déu, Barcelona, Spain

||Department of Paediatrics, University Hospital Motol, Prague, Czech Republic

Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary

#Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy

**Department of Woman, Child and General and Specialistic Surgery, University of Campania “Luigi Vanvitelli”, Napoli, Italy

††University Children's Hospital, Zurich, Switzerland

‡‡Schneider Children's Hospital, Petach Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel

§§Pediatric Department, University of Messina, Italy

||||National Children's Research Centre, Royal College of Surgeons of Ireland and University College Dublin, Ireland

¶¶Southampton Children's Hospital, UK

##Helsinki University Children's Hospital, Department of Pediatric Surgery, Helsinki, Finland

***Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

†††University of Ioannina School of Medical Sciences Ioannina, Greece

‡‡‡Barts and the London School of Medicine, Queen Mary University of London, UK

§§§Pediatric Gastroenterology and Nutrition Unit. Hospital Materno. IBIMA. Málaga, Spain

||||||||||Child Life and Health, University of Edinburgh, UK

¶¶¶BC Children's Hospital, University of British Columbia, Vancouver BC, Canada

###The Royal Hospital for Children, Glasgow, UK.

Address correspondence and reprint requests to Dan Turner, MD, PhD, Shaare Zedek Medical Center, Jerusalem, Israel. (e-mails:

Received 16 December, 2017

Accepted 17 April, 2018

Funding: European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).


Conflict of interests: DT- last 3 years received consultation fee, research grant, royalties, or honorarium from Janssen, Pfizer, Hospital for Sick Children (PUCAI royalties from industry trials), Ferring, AstraZeneca, Abbvie, Takeda, Ferring, Boehringer Ingelheim, Biogen, Atlantic Health, Shire, Celgene

JMdC-last 3 years received consultation fee, research grant, travel grant, or honorarium from Abbvie, Abbot, Nestle, MSD, Otsuka, Faes, Nutricia, Fresenius

JB received honoraria, speaker's fees and/or congress fees from AbbVie, MSD, Nestle, Nutricia and Biocodex.

GV- received consultation fee from Nestle, Danone and Abbvie.

MA last 3 years received honorarium from AbbVie

FMR received speaker fees from: Schering-Plough, Nestlé, Mead Johnson, Ferring, MSD, Johnson & Johnson, Centocor, AbbVie; serves as a board member for: SAC:DEVELOP (Johnson & Johnson), CAPE (ABBVIE), LEA (ABBVIE) and has been invited to MSD France, Nestlé Nutrition Institute, Nestlé Health Science, Danone, TAKEDA, CELGENE, BIOGEN, SHIRE, PFIZER, THERAKOS

AA- Received research grant from AbbVie

SH- received a travel bursary from AbbVie

LdR – last 3 years received consultation fee, research grant, or honorarium from ZonMw (national health institute), Janssen, Pfizer, Mundipharma, Shire and Abbvie

KK - Honoraria for consulting services (educational services, scientific articles, participation in Advisory Boards, clinical trials, other) from the companies as follows AbbVie, ENORASIS, Ferring, JANNSEN, MSD and Takeda

VNL last 3 years received consultation fee or honorarium from Abbvie, Otsuka and Nestlé Health Science

SL – last 2 years received honorarium from Janssen

RKR has received speaker's fees, travel support, or has performed consultancy work with Nestlé Health Science, AbbVie, Napp, Celltrion, Shire and Janssen.

MS, CS, CB, CR No conflict of interests to declare

EO has received honoraria from Abbvie.

NC research funding for trials, speaker fees and travel for conferences from Takeda, Shire, Celgene, Roche

MP lectures and congress fees sponsored by Astellas, Baxter and Shire.

AMG consultancy, speakers fees or research support for Abbvie, Celgene, Ferring, Gilead, Janssen, Pfizer and Takeda.

DCW has received speaker's fees, travel support, or has performed consultancy work with Abbvie, Takeda and Falk.

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