Medical therapy for ulcerative colitis in childhood

Corticosteroids remain the primary therapeutic agent to induce remission in moderate to severe ulcerative colitis (UC) and Crohn's disease because of their rapidity of action in comparison to other agents. Mild UC and/or Crohn's disease of the colon and terminal small bowel may be treated with azulfidine first. However, if patients are intolerant of these medications, dipentum or asacol may be used. Occasionally, patients with Crohn's colitis but not UC may respond to metronidazole. Immunosuppressive agents such as 6-mercaptopurine are very useful for steroid-dependent inflammatory bowel disease, as a substitute for long-term corticosteroids. Cyclosporine, although it has been proposed as an alternative to other antimetabolite or immunosuppressive therapy, is of benefit in fewer than 25% of cases of UC or Crohn's disease. Rowasa enemas are useful for left-sided disease in UC or Crohn's disease of the colon; however, use in children may be difficult in view of psychosocial issues that must be considered.