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Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis; An Evidence-based Consensus 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 H.†††; Croft, Nick‡‡‡; Navas-López, Víctor Manuel§§§; 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.0000000000002036
Societal Paper: PDF Only

Background and aim: Acute severe colitis (ASC) is one of the few emergencies in paediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts.

Methods: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including two face-to-face meetings, was followed by voting by the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts).

Results: A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index (PUCAI). Several topics have been altered since the previous 2011 guidelines and from those published in adults.

Discussion: These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.

*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; 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

†††Medical School and University Hospital of 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-mail:;;

Received 16 December, 2017

Accepted 16 April, 2018

D.T., F.M.R., E.O.-M., A.M.G.,, J.B., G.V., M.A., C.S., C.P.B., A.A., C.R., S.H., M.S., M.P.,, K.H.K., N.C., V.M.N.-L., D.C.W., S.L. and R.K.R. contributed equally to this work.

Disclaimer: ESPGHAN is not responsible for the practices of physicians and provides guidelines and position papers as indicators of best practice only. Diagnosis and treatment is at the discretion of physicians.

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, Nestl,, 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, Nestl, Nutrition Institute, Nestl, 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 Nestl, Health Science

SL - last 2 years received honorarium from Janssen

RKR has received speaker's fees, travel support, or has performed consultancy work with Nestl, 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.

“ASC Tables of evidence 14.12.17”, Supplemental Digital Content,

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