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Review
. 2016 May;101(5):469-74.
doi: 10.1136/archdischild-2014-307218. Epub 2015 Nov 9.

Management of ulcerative colitis

John M Fell  1 , Rafeeq Muhammed  2 , Chris Spray  3 , Kay Crook  4 , Richard K Russell  5 ; BSPGHAN IBD working group
Collaborators, Affiliations
Review

Management of ulcerative colitis

John M Fell et al. Arch Dis Child. 2016 May.

Abstract

Ulcerative colitis (UC) in children is increasing. The range of treatments available has also increased too but around 1 in 4 children still require surgery to control their disease. An up-to-date understanding of treatments is essential for all clinicians involved in the care of UC patients to ensure appropriate and timely treatment while minimising the risk of complications and side effects.

Keywords: Gastroenterology; Multidisciplinary team-care; Paediatric Surgery.

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Figures

Figure 1
Figure 1
Suggested pathway for reacting to thiopurine metabolite results. This algorithm is designed predominantly to help patients with active disease as we assume patients in remission would not routinely have levels measured. *The majority of patients with a raised 6-methyl mercaptopurine (6-MMP) need no action taken unless there is evidence of a transaminitis. The established ranges for 6-thioguanine (6-TGN) levels and 6-MMP commonly used in the UK are 235–450 pmol (Purine Research Laboratory at St Thomas, London). Low and high in the figure refer to values lying outside these ranges. Allopurinol and dose reduction is used rarely in paediatric practice to help with thiopurine toleration, but should only be considered in specialist units with appropriate experience and monitoring arrangements in place.
Figure 2
Figure 2
Simplified algorithm of assessment of children with acute severe colitis. This simplified algorithm emphasises the need for daily monitoring with the Paediatric Ulcerative Colitis Activity Index (PUCAI) and timely escalation of therapy in non-responsive cases according to fixed timelines. At day 3 review progress, at day 5 escalate therapy if PUCAI is >65.
Figure 3
Figure 3
Suggested pathway for diagnosis and treatment of iron-deficiency anaemia. CRP, C reactive protein; ESR, erythrocyte sedimentation rate; Hb, haemoglobin; Hct, haematocrit; IBD, inflammatory bowel disease; ID, iron deficiency; IDA, iron deficiency anaemia; MCV, mean corpuscular volume; PUCAI, Paediatric Ulcerative Colitis Activity Index; PCDAI, paediatric Crohn's disease activity index.
See this image and copyright information in PMC

References

    1. Van Limbergen J, Russell RK, Drummond HE, et al. . Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 2008;135:1114–22. 10.1053/j.gastro.2008.06.081 - DOI - PubMed
    1. Levine A, Koletzko S, Turner D, et al. . The ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014;58:795–806. - PubMed
    1. Quail MA, Russell RK, Van Limbergen JE, et al. . Fecal calprotectin complements routine laboratory investigations in diagnosing childhood inflammatory bowel disease. Inflamm Bowel Dis 2009;15:756–9. 10.1002/ibd.20820 - DOI - PubMed
    1. Hansen R, Russell RK, Muhammed R. et al. . Recent Advances in Paediatric Gastroenterology. Arch Dis Child 2015;100:886–90. 10.1136/archdischild-2014-307089 - DOI - PubMed
    1. Jose FA, Garnett EA, Vittinghoff E, et al. . Development of extraintestinal manifestations in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis 2009;15:63–8. 10.1002/ibd.20604 - DOI - PMC - PubMed

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