Severe Colitis in Children

Steroid response in moderate to severe pediatric ulcerative colitis: a single center’s experience

“…Moderate/severe disease was defined as the occurrence of five or more stools per day, and the daily presence of blood, with or without presence of systemic symptoms. [6,7] The following variables were recorded from the patient files: demographics, clinical and physical findings at initial examination, laboratory, endoscopy and histology findings, and extent of the disease. The extent of the disease was defi ned as ulcerative proctitis if the involvement extended to the rectosigmoid region or 20 cm from the anal margin, pancolitis if the involvement extended to the cecum, and left-sided colitis if the involvement was above the rectosigmoid junction without the involvement of the cecum.…”

Acute severe ulcerative colitis in children: A systematic review

“…The results from studies evaluating the use of antibiotics in this setting remain controversial and the reader is referred to a previous review on severe pediatric UC. 9 There is no firm evidence to support their use and guidelines in adults have not recommended empiric treatment. 27 However, it is not unreasonable to initiate empiric antibiotic treatment (such as metronidazole) in children severe enough to require hospitalization, in view of the low quality of studies on the topic, the high frequency of Clostridium difficile infection in admitted patients with UC, 28 the relative safety of antibiotics, and the high failure rate of standard medical therapy.…”

“…Clinical guidelines recommend that second-line therapy be commenced if no response to corticosteroids is noted within 3-10 days of initiating intravenous therapy. 8,9,23,27,33,54,55 Introduction of second-line therapy should ideally be based on early recognition of patients likely to fail corticosteroid therapy. Four indices in adults have been developed to predict corticosteroid failure on the third treatment day in order to facilitate timely introduction of second-line therapy when needed.…”

“…Since the previous review on acute severe colitis in children 5 years ago, several large pediatric studies have been published and infliximab has been in increasing use. 9 This review aims to systematically review and summarize the current knowledge of pediatric severe UC and to provide, whenever possible, an evidence-based approach to management.…”

Nutritional and surgical treatment of chronic inflammatory bowel disease

“…Zunächst wird versucht, diese durch eine adäquate medikamentöse Therapie (Steroide plus Rescue-Immunsuppression) zu beherrschen [40,70], wobei als Rescue-Immunsuppressiva Ciclosporin A, Infliximab und Tacrolimus in Frage kommen. Schwierig sind das optimale Timing und die korrekte Indikationsstellung zur Operation [70]: Kommt es innerhalb von 7-10 Tagen nach zusätzlichem Einsatz der Immunsuppressiva nicht zu einem Ansprechen auf die Therapie [objektiviert durch die Messung des pädiatrischen Aktivitätsindexes PUCAI ("pediatric ulcerative colitis activity index") [ …”