title: Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era.
abstract: Approximately one-third of children with ulcerative colitis will experience at least 1 attack of acute severe colitis (ASC) before 15 years of age. Severe disease can be defined in children when Pediatric Ulcerative Colitis Activity Index is >65 and/or ≥6 bloody stools per day, and/or 1 of the following: tachycardia, fever, anemia, and elevated erythrocyte sedimentation rate with or without systemic toxicity. Our aim was to provide practical suggestions on the management of ASC in children. The goal of medical therapy is to avoid colectomy while preventing complications of disease, side effects of medications, and mortality.
  
  
  
  A systematic search was carried out through Medline via PubMed to identify all articles published in English to date, based on the following keywords "ulcerative colitis," "pediatric ulcerative colitis," "biological therapy," and "acute severe colitis." Multidisciplinary clinical evaluation is recommended to identify early nonresponders to conventional treatment with intravenous corticosteroids, and to start, if indicated, second-line therapy or "rescue therapy," such as calcineurin inhibitors (cyclosporine, tacrolimus) and anti-tumor necrosis factor molecules (infliximab).
  
  
  
  Pediatric Ulcerative Colitis Activity Index is a valid predictive tool that can guide clinicians in evaluating response to therapy. Surgery should be considered in the case of complications or rapid clinical deterioration during medical treatment.
  
  
  
  Several pitfalls may be present in the management of ASC, and a correct clinical and therapeutic approach is recommended to reduce surgical risk.
authors.affiliation: Inflammatory Bowel Disease Unit, Pediatric Department, University of Messina, Messina, Italy; and romanoc@unime.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Romano
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Sana
authors.initials: S
authors.lastname: Syed
authors.affiliation: Inflammatory Bowel Disease Unit, Pediatric Department, University of Messina, Messina, Italy; and.
authors.forename: Simona
authors.initials: S
authors.lastname: Valenti
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D002648:Child; D003093:Colitis, Ulcerative / Q000145:classification / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D065095:Calcineurin Inhibitors; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab; D016559:Tacrolimus