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Pediatric ulcerative colitis: a practical guide to management
Brian P Regan1, Athos Bousvaros
1Department of Gastroenterology, Inflammatory Bowel Disease Center, GI Division-Hunnewell Ground, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA, Brian.Regan@childrens.harvard.edu.
Insights
Pediatric ulcerative colitis (UC) management involves diagnosis via colonoscopy and treatment escalation based on severity. Therapies range from mesalamine for mild cases to biologics and surgery for severe or refractory ulcerative colitis.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
Background:
- Ulcerative colitis (UC) is a chronic gastrointestinal inflammatory disorder of unknown cause.
- Pediatric UC presentation requires excluding infection and confirming chronic colitis via colonoscopy.
Purpose of the Study:
- To outline the diagnostic work-up for pediatric ulcerative colitis.
- To present a treatment algorithm for managing mild, moderate, and severe pediatric UC.
- To discuss available pharmacologic and surgical treatment options.
Main Methods:
- Review of current diagnostic criteria for pediatric UC.
- Analysis of treatment strategies based on disease severity (mild, moderate, severe).
- Evaluation of induction and maintenance therapies, including biologics and surgical options.
Main Results:
- Mild UC typically managed with mesalamine.
- Moderate UC often initiated with oral prednisone, with maintenance options including mesalamine, thiopurines, or biologics.
- Severe UC requires intravenous corticosteroids, with colectomy or rescue therapy (biologics, calcineurin inhibitors) for nonresponders.
Conclusions:
- Effective management of pediatric UC requires a stepwise approach tailored to disease severity.
- While medical therapies offer options, 1-year remission rates for severe UC responders to rescue therapy are below 50%.
- Further research into optimizing long-term remission in severe pediatric UC is warranted.
Abstract:
Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract of unknown etiology that frequently presents in the pediatric population. The evaluation of pediatric UC involves excluding infection, and a colonoscopy that documents the clinical and histologic features of chronic colitis. Initial management of mild UC is typically with mesalamine therapy for induction and maintenance. Moderate UC is often initially treated with oral prednisone. Depending on disease severity and response to prednisone, maintenance options include mesalamine, mercaptopurine, azathioprine, infliximab, or adalimumab. Severe UC is typically treated with intravenous corticosteroids. Corticosteroid nonresponders should either undergo a colectomy or be treated with second-line medical rescue therapy (infliximab or calcineurin inhibitors). The severe UC patients who respond to medical rescue therapy can be maintained on infliximab or thiopurine, but 1-year remission rates for such patients are under 50 %. These medications are discussed in detail along with the initial work-up and a treatment algorithm.
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