Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition
Por:
Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, Martín-de-Carpi J, Bronsky J, Veres G, Aloi M, Strisciuglio C, Braegger CP, Assa A, Romano C, Hussey S, Stanton M, Pakarinen M, de Ridder L, Katsanos K, Croft N, Navas-López V, Wilson DC, Lawrence S and Russell RK
Publicada:
1 ago 2018
Ahead of Print:
30 may 2018
Resumen:
Background: The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with similar to 20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of pediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points.
Methods: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before 2 face-to-face meetings. All 40 included recommendations and 86 practice points were endorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate.
Results: These guidelines discuss how to optimize the use of mesalamine (including topical), systemic and locally active steroids, thiopurines and, for more severe disease, biologics. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision-making based on clinical assessment and the Paediatric UC Activity Index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, as well as other management considerations around pouchitis, extraintestinal manifestations, nutrition, growth, psychology, and transition. A brief section on disease classification using the PIBD-classes criteria and IBD-unclassified is also part of these guidelines.
Conclusions: These guidelines provide a guide to clinicians managing children with UC and IBD-unclassified management to provide modem management strategies while maintaining vigilance around appropriate outcomes and safety issues.
Filiaciones:
Turner D:
Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
Ruemmele FM:
Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France
Orlanski-Meyer E:
Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
Griffiths AM:
The Hospital for Sick Children, University of Toronto, Canada
Martín-de-Carpi J:
Hospital Sant Joan de Déu, Barcelona, Spain
Bronsky J:
Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
Veres G:
Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary
Aloi M:
Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy
Strisciuglio C:
Department of Woman, Child and General and Specialistic Surgery, University of Campania Luigi Vanvitelli, Napoli, Italy
Braegger CP:
University Children's Hospital, Zurich, Switzerland
Assa A:
Schneider Children's Hospital, Petach Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
Romano C:
Pediatric Department, University of Messina, Italy
Hussey S:
National Children's Research Centre, Royal College of Surgeons of Ireland and University College Dublin, Ireland
Stanton M:
Southampton Children's Hospital, UK
Pakarinen M:
Helsinki University Children's Hospital, Department of Pediatric Surgery, Helsinki, Finland
de Ridder L:
Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
Katsanos K:
University of Ioannina School of Medical Sciences Ioannina, Greece
Croft N:
Barts and the London School of Medicine, Queen Mary University of London, UK
Navas-López V:
Pediatric Gastroenterology and Nutrition Unit. Hospital Materno. IBIMA. Málaga, Spain
Wilson DC:
Child Life and Health, University of Edinburgh, UK
Lawrence S:
BC Children's Hospital, University of British Columbia, Vancouver BC, Canada
Russell RK:
The Royal Hospital for Children, Glasgow, UK
Green Published, Green Submitted, Bronze, Green Accepted
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