What is the optimal management approach for pediatric patients with severe ulcerative colitis?

Abstract

The treatment of severe ulcerative colitis in pediatric patients presents a unique challenge to clinicians. In this Practice Point commentary we discuss the findings and limitations of a retrospective, longitudinal cohort study by Turner and colleagues, which provides valuable information on response to and predictors of outcome from corticosteroid therapy for pediatric patients with severe ulcerative colitis. The results suggest that daily monitoring of response to therapy and the Pediatric Ulcerative Colitis Activity Index score can accurately predict failure to respond to therapy. Second-line medical therapy (e.g. infliximab, ciclosporine and tacrolimus) should be considered, particularly for cases of new-onset severe pediatric ulcerative colitis, before colectomy to allow for better timing of surgery and to exclude the possibility of Crohn's disease colitis.