Management of paediatric ulcerative colitis, part 1: Ambulatory care-An updated evidence-based consensus guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation.
Por:
Wine E, Aloi M, Van Biervliet S, Bronsky J, Martín-de-Carpi J, Gasparetto M, Gianolio L, Gordon H, Hojsak I, Hudson AS, Hussey S, van Limbergen J, Miele E, Norsa L, Olén O, Pellino G, van Rheenen P, de Ridder L, Russell RK, Shouval DS, Trindade E, Turner D, Wilson DC, Yerushalmy Feler A and Assa A
Publicada:
1 sep 2025
Ahead of Print:
18 jul 2025
Resumen:
OBJECTIVES: Despite advances in the management of ambulatory paediatric ulcerative colitis (UC), challenges remain as many patients are refractory to therapy and some require colectomy. The aim of these guidelines is to provide an update on optimal care for UC through detailed recommendations and practice points. METHODS: These guidelines are an update to those published in 2018 and are a joint effort of the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation. An extensive literature search with subsequent evidence appraisal using the Oxford methodology was performed, followed by three online voting sessions and a consensus face-to-face meeting. Thirty-nine recommendations and 77 practice points were endorsed by the 25 experts with at least an 84% consensus rate. RESULTS: Robust evidence-based recommendations and detailed practice points are provided. In addition to reemphasising and updating the role of more 'traditional' UC therapies, these guidelines outline optimising the use of antitumour necrosis factor therapies and integrating newer biologics and small molecules, as well as supportive therapy, to improve outcomes and provide an updated management algorithm. Measurement and monitoring tools and decision aids are provided, and additional aspects, including nutritional support, extraintestinal manifestations, pouchitis, inflammatory bowel disease-unclassified and patient support, are discussed. Some aspects, including surgery and thromboprophylaxis, are covered in the acute severe UC guidelines. CONCLUSIONS: These guidelines serve as an aid in managing children with UC through a combination of evidence-based recommendations and more practical practice points in the ambulatory setting.
Filiaciones:
Wine E:
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
University of Toronto, Toronto, Ontario, Canada
Department of Pediatrics, Division of Pediatric Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Aloi M:
Pediatric Gastroenterology, Hepatology and Cystic Fibrosis Unit, Department of Pathophysiology and Transplantation, University of Milan - Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico di Milano, Milan, Italy
Van Biervliet S:
Pediatric Gastroenterology, Ghent University Hospital, Ghent, Belgium
Bronsky J:
Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
Martín-de-Carpi J:
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
Gasparetto M:
Department of Paediatric Gastroenterology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals, Faculty of Medicine and Health Science, University of East Anglia (UEA), Norwich, UK
Gianolio L:
Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
Gordon H:
Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
Hojsak I:
Department of Pediatrics, Children's Hospital Zagreb, University of Zagreb Medical School, Referral Center for Pediatric Gastroenterology and Nutrition, Zagreb, Croatia
Hudson AS:
Department of Pediatrics, Division of Pediatric Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Hussey S:
DOCHAS Group, Children's Health Ireland, University College Dublin, Dublin, Ireland
van Limbergen J:
Division of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
Miele E:
Section of Paediatrics, Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
Norsa L:
Department of Paediatric Gastroenterology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals, Faculty of Medicine and Health Science, University of East Anglia (UEA), Norwich, UK
Olén O:
Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
Pellino G:
Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona UAB, Barcelona, Spain
Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
van Rheenen P:
Department of Paediatric Gastroenterology Hepatology and Nutrition, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
de Ridder L:
Department of Paediatric Gastroenterology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
Russell RK:
Department of Paediatric Gastroenterology, Royal Hospital for Children and Young People, Edinburgh, Scotland, UK
Shouval DS:
Schneider Children's Medical Center of Israel, Institute of Gastroenterology, Nutrition and Liver Diseases, Petah Tikva, Israel
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Trindade E:
Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar Universitário São João, Porto, Portugal
Turner D:
Shaare Zedek Medical Centre, The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Eisenberg R&D Authority, The Hebrew University, Jerusalem, Israel
Wilson DC:
Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Scotland, UK
Yerushalmy Feler A:
Pediatric Gastroenterology Institute, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
Assa A:
Shaare Zedek Medical Centre, The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Eisenberg R&D Authority, The Hebrew University, Jerusalem, Israel
Green Submitted
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