Differences in the management of pediatric and adult onset ulcerative colitis - lessons from the joint ECCO and ESPGHAN consensus guidelines for the management of pediatric ulcerative colitis

  • F.M. R
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Abstract

An expert panel of the European Crohn's and Colitis Organisation (ECCO) and European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) initiated a consensus process to produce the first pediatric specific ulcerative colitis (UC) guidelines based on a systematic literature review. Treatment strategies must reflect that pediatric-onset UC has a slightly different phenotype than adult-onset disease with more often extensive (pancolitis) and more aggressive disease course. Other pediatric-specific aspects include growth, puberty, bone density accrual and emotional development and body image acquisition. These differences and others influenced the development of pediatric treatment algorithms. It is recommended that virtually all children with UC must be treated with some maintenance therapy and 5-ASA requirement and dosing are often higher in children. A larger number of children are at risk for steroid-dependency, and this should not be tolerated; steroid sparing strategies with early use of immunosuppressors are recommended in high-risk patients. On the other hand, the safety profile of immunosuppressive therapy in children includes the rare forms of lymphomas and many future treatment years. Colectomy and pouch formation should be balanced in the treatment algorithms against the higher rate of future infertility in girls. The acute and on-going management of pediatric UC should be guided by evidence- and consensus-based balanced decisions, reflecting a vision of long-term treatment goals. © 2013 European Crohn's and Colitis Organisation.

Author-supplied keywords

  • *acetylsalicylic acid/ad [Drug Administration]
  • *acetylsalicylic acid/cm [Drug Comparison]
  • *acetylsalicylic acid/dt [Drug Therapy]
  • *acetylsalicylic acid/po [Oral Drug Administration
  • *acetylsalicylic acid/tp [Topical Drug Administrat
  • *adult disease/dm [Disease Management]
  • *adult disease/dt [Drug Therapy]
  • *adult disease/su [Surgery]
  • *childhood disease/dm [Disease Management]
  • *childhood disease/dt [Drug Therapy]
  • *childhood disease/su [Surgery]
  • *colon resection
  • *immunosuppressive agent/ae [Adverse Drug Reaction
  • *immunosuppressive agent/dt [Drug Therapy]
  • *immunosuppressive treatment
  • *infliximab/cb [Drug Combination]
  • *infliximab/dt [Drug Therapy]
  • *onset age
  • *practice guideline
  • *ulcerative colitis/dm [Disease Management]
  • *ulcerative colitis/dt [Drug Therapy]
  • *ulcerative colitis/su [Surgery]
  • adjuvant therapy
  • algorithm
  • antibiotic agent/dt [Drug Therapy]
  • antibiotic therapy
  • article
  • azathioprine/cm [Drug Comparison]
  • azathioprine/dt [Drug Therapy]
  • body image
  • bone density
  • cancer risk
  • child growth
  • consensus
  • decision making
  • disease course
  • disease severity
  • drug dose reduction
  • drug megadose
  • drug safety
  • emotion
  • evidence based practice
  • female infertility
  • glucocorticoid/dt [Drug Therapy]
  • high risk patient
  • human
  • ileum pouch
  • long term care
  • lymphoma/si [Side Effect]
  • maintenance therapy
  • medical society
  • mercaptopurine/cb [Drug Combination]
  • mercaptopurine/cm [Drug Comparison]
  • mercaptopurine/dt [Drug Therapy]
  • monotherapy
  • pancolitis
  • phenotype
  • prednisone/dt [Drug Therapy]
  • priority journal
  • probiotic agent/dt [Drug Therapy]
  • proctitis
  • puberty
  • quality of life
  • remission
  • risk benefit analysis
  • steroid therapy
  • tumor necrosis factor inhibitor/dt [Drug Therapy]

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Authors

  • Ruemmele F.M.

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