Practice Guidelines | Published:

Consensus for Managing Acute Severe Ulcerative Colitis in Children: A Systematic Review and Joint Statement From ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN

The American Journal of Gastroenterology volume 106, pages 574588 (2011) | Download Citation



Acute severe ulcerative colitis (ASC) is a potentially life-threatening disease. We aimed to formulate guidelines for managing ASC in children based on systematic review of the literature and robust consensus process. This manuscript is a product of a joint effort of the ECCO (European Crohn's and Colitis Organization), the Pediatric Porto Inflammatory Bowel Disease (IBD) Working group of ESPGHAN (European Society of Pediatric Gastroenterology, Hepatology, and Nutrition) and ESPGHAN.


A group of 19 experts in pediatric IBD participated in an iterative consensus process including two face-to-face meetings. A total of 17 predefined questions were addressed by working subgroups based on a systematic review of the literature.


The recommendations and practice points were eventually endorsed with a consensus rate of at least 95% regarding: definitions, initial evaluation, standard therapy, timing of second-line therapy, the role of endoscopic evaluation and heparin prophylaxis, how to administer second-line medical therapy, how to assess response, surgical considerations, and discharge recommendations. A management flowchart is presented based on daily scoring of the Pediatric Ulcerative Colitis Activity Index (PUCAI), along with 28 formal recommendations and 34 practice points.


These guidelines provide clinically useful points to guide the management of ASC in children. Taken together, the recommendations offer a standardized protocol that allows effective monitoring of disease progress and timely treatment escalation when needed.

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Author information


  1. Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel

    • Dan Turner
  2. Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK

    • Simon P L Travis
  3. Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    • Anne M Griffiths
    •  & Jacob C Langer
  4. Université Paris Descartes, APHP, Paris, France

    • Frank M Ruemmele
  5. Pediatric Gastroenterology Unit, Tel-Aviv University, Wolfson Medical Center, Tel Aviv, Israel

    • Arie Levine
  6. Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada

    • Eric I Benchimol
  7. Department of Pediatrics, Pediatric IBD, Cedars Sinai Medical Center, Los Angeles, California, USA

    • Marla Dubinsky
  8. Department of Gastroenterology and Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia

    • George Alex
  9. Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    • Robert N Baldassano
  10. Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA

    • Robert Shamberger
    •  & Athos Bousvaros
  11. Connecticut Children's Medical Center, Hartford, University of Connecticut School of Medicine, Farmington, Connecticut, USA

    • Jeffrey S Hyams
  12. Sapienza University of Rome, Rome, Italy

    • Salvatore Cucchiara
  13. Department of Pediatric Gastroenterology, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands

    • Johanna C Escher
  14. Division of Pediatric Gastroenterology, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore–LIJ Health System, New Hyde Park, New York, USA

    • James Markowitz
  15. Child Life and Health, University of Edinburgh, Edinburgh Scotland, UK

    • David C Wilson
  16. Division of Gastroenterology, University Hospital Leuven, Leuven, Belgium

    • Gert van Assche
  17. Royal Hospital for Sick Children, Glasgow, Scotland, UK

    • Richard K Russell
  18. All authors contributed equally

    • Dan Turner
    • , Simon P L Travis
    • , Anne M Griffiths
    • , Frank M Ruemmele
    • , Arie Levine
    • , Eric I Benchimol
    • , Marla Dubinsky
    • , George Alex
    • , Robert N Baldassano
    • , Jacob C Langer
    • , Robert Shamberger
    • , Jeffrey S Hyams
    • , Salvatore Cucchiara
    • , Athos Bousvaros
    • , Johanna C Escher
    • , James Markowitz
    • , David C Wilson
    • , Gert van Assche
    •  & Richard K Russell


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Competing interests

Guarantor of the article: Dan Turner, MD, PhD.

Specific author contributions: All authors contributed equally to the inception of the idea, formulation of the predefined questions, derivation of the initial draft, further formatting and revisions, participation in two face-to-face discussions, and final preparation of the manuscript.

Financial support: The face-to-face meetings were funded by ECCO (without travel awards).

Potential competing interests: D.T.: speaking bureau, research support, consultant or travel grants from Proctor and Gamble, Falk Pharma, MSD, and Ferring Pharmaceuticals; S.P.L.T.: advisor to, lecturer for, or in receipt of unrestricted educational grants from Abbott, MSD, Ferring Pharmaceuticals, Shire, and Warner Chilcott; A.M.G.: research support from Schering Canada, consultant for Abbott, Axcan Pharma, UCB Pharma, and Schering Canada, and speaker's fees from Merck and Abbott; A.L.: research support from Falk Pharma and honoraria from Falk Pharma and MSD; E.I.B.: speaker's fees from Mead Johnson Nutrition and Ferring and consultant and received educational funds from Schering-Plough/Merck Canada; M.D.: consultant for Prometheus Labs, Abbott, Centocor, UCB, and Shire, and research support from UCB and Centocor; G.A.: Remicade Paediatric Crohn's disease advisory board; R.N.B.: consultant, Centocor-Ortho Biotech; J.S.H.: Centocor—research support, advisory board, speaking bureau, Abbott—research support; A.B.: research support within the last year from UCB, and Merck, speaker's bureau, and consultant from Milennium; J.M.: consultant and research support: Centocor-Ortho Biotech and Prometheus Laboratories; honoraria: Falk Foundation and Abbott Nutritionals; research support: Exagen Laboratories; R.K.R.: speaker's fees, travel support, or participated in medical board meetings with MSD Immunology, Abbott, Dr Falk, and Ferring Pharmaceuticals.

Corresponding author

Correspondence to Dan Turner.

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