Management of mild to moderate ulcerative colitis in children and adolescents
- Athos Bousvaros, MD
Athos Bousvaros, MD
- Associate Professor of Pediatrics
- Harvard Medical School
- Mala Setty, MD
Mala Setty, MD
- Assistant Professor, UCSF Department of Pediatrics;
- Associate Gastroenterologist, UCSF Benioff Children's Hospital Oakland
- Jess L Kaplan, MD
Jess L Kaplan, MD
- Instructor of Pediatrics
- Harvard Medical School
Inflammatory bowel disease (IBD) is comprised of two major disorders, ulcerative colitis (UC) and Crohn disease (CD). These disorders have distinct pathologic and clinical characteristics (table 1), but their pathogenesis remains poorly understood. (See "Definition, epidemiology, and risk factors in inflammatory bowel disease".)
Approximately 20 percent of patients with CD and 12 percent of those with UC develop symptoms before 20 years of age . The development of IBD early in life has implications that are not encountered in adults. Clinicians caring for children and adolescents with CD or UC not only must treat the underlying disease and its complications but must also carefully monitor linear growth, skeletal development, and puberty, as well as how the child's maturation and psychological health are affected by living with a chronic disease. In addition, some therapies used for older patients cannot be applied to young children because many children are unable to swallow pills or refuse enema therapy.
The treatment of UC in children and adolescents is reviewed here. Other aspects of the diagnosis and management of children with UC are discussed in separate topic reviews:
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- CLINICAL MANIFESTATIONS
- LEFT-SIDED DISEASE AND PANCOLITIS
- Clinical assessment
- - Diagnosis
- - Disease severity
- - Evaluation for infectious colitis
- - Determination of response to therapy
- Initial management
- - Mild disease
- - Moderate disease
- Subsequent management
- - Maintenance of remission
- - Steroid-dependent disease
- Sequential or combination therapy
- Second-line options
- Other options
- IMPORTANT HEALTH MAINTENANCE ISSUES
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS