title: Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN.
abstract: OBJECTIVE
  Acute severe ulcerative colitis (ASC) is a potentially life-threatening disease. We aimed to formulate guidelines for managing ASC in children based on systematic review of the literature and robust consensus process. This manuscript is a product of a joint effort of the ECCO (European Crohn's and Colitis Organization), the Pediatric Porto Inflammatory Bowel Disease (IBD) Working group of ESPGHAN (European Society of Pediatric Gastroenterology, Hepatology, and Nutrition) and ESPGHAN.
  
  
  METHODS
  A group of 19 experts in pediatric IBD participated in an iterative consensus process including two face-to-face meetings. A total of 17 predefined questions were addressed by working subgroups based on a systematic review of the literature.
  
  
  RESULTS
  The recommendations and practice points were eventually endorsed with a consensus rate of at least 95% regarding: definitions, initial evaluation, standard therapy, timing of second-line therapy, the role of endoscopic evaluation and heparin prophylaxis, how to administer second-line medical therapy, how to assess response, surgical considerations, and discharge recommendations. A management flowchart is presented based on daily scoring of the Pediatric Ulcerative Colitis Activity Index (PUCAI), along with 28 formal recommendations and 34 practice points.
  
  
  CONCLUSIONS
  These guidelines provide clinically useful points to guide the management of ASC in children. Taken together, the recommendations offer a standardized protocol that allows effective monitoring of disease progress and timely treatment escalation when needed.
authors.affiliation: Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel. turnerd@szmc.org.il
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Simon P L
authors.initials: SP
authors.lastname: Travis
authors.forename: Anne M
authors.initials: AM
authors.lastname: Griffiths
authors.forename: Frank M
authors.initials: FM
authors.lastname: Ruemmele
authors.forename: Arie
authors.initials: A
authors.lastname: Levine
authors.forename: Eric I
authors.initials: EI
authors.lastname: Benchimol
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.forename: George
authors.initials: G
authors.lastname: Alex
authors.forename: Robert N
authors.initials: RN
authors.lastname: Baldassano
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.forename: Robert
authors.initials: R
authors.lastname: Shamberger
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hyams
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Escher
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: David C
authors.initials: DC
authors.lastname: Wilson
authors.forename: Gert
authors.initials: G
authors.lastname: van Assche
authors.forename: Richard K
authors.initials: RK
authors.lastname: Russell
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016145:Endoscopy, Digestive System; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use; D018529:Nutritional Support; D010166:Palliative Care; D012720:Severity of Illness Index; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D019804:Mesalamine; D006493:Heparin