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Pediatric Ulcerative Colitis: A Practical Guide to Management

  • Therapy in Practice
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Abstract

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract of unknown etiology that frequently presents in the pediatric population. The evaluation of pediatric UC involves excluding infection, and a colonoscopy that documents the clinical and histologic features of chronic colitis. Initial management of mild UC is typically with mesalamine therapy for induction and maintenance. Moderate UC is often initially treated with oral prednisone. Depending on disease severity and response to prednisone, maintenance options include mesalamine, mercaptopurine, azathioprine, infliximab, or adalimumab. Severe UC is typically treated with intravenous corticosteroids. Corticosteroid nonresponders should either undergo a colectomy or be treated with second-line medical rescue therapy (infliximab or calcineurin inhibitors). The severe UC patients who respond to medical rescue therapy can be maintained on infliximab or thiopurine, but 1-year remission rates for such patients are under 50 %. These medications are discussed in detail along with the initial work-up and a treatment algorithm.

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Acknowledgements/Conflicts of Interest

A. Bousvaros has received research grants from Prometheus, Merck, and UCB, has consulted for Dyax, Millenium, Cubist, UCB, and Nutricia, is on the speakers bureau for Merck, and has received royalties from UpToDate. B. Regan declares no conflicts of interest. No sources of funding were used to prepare this review.

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  1. Department of Gastroenterology, Inflammatory Bowel Disease Center, GI Division-Hunnewell Ground, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Brian P. Regan & Athos Bousvaros

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Correspondence to Athos Bousvaros.

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Regan, B.P., Bousvaros, A. Pediatric Ulcerative Colitis: A Practical Guide to Management. Pediatr Drugs 16, 189–198 (2014). https://doi.org/10.1007/s40272-014-0070-8

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