{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:01:40Z","timestamp":1780923700257,"version":"3.54.1"},"reference-count":51,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,5,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVE:<\/jats:title><jats:p>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 &amp;gt;65 and\/or \u22656 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>A systematic search was carried out through Medline via PubMed to identify all articles published in English to date, based on the following keywords \u201culcerative colitis,\u201d \u201cpediatric ulcerative colitis,\u201d \u201cbiological therapy,\u201d and \u201cacute severe colitis.\u201d Multidisciplinary clinical evaluation is recommended to identify early nonresponders to conventional treatment with intravenous corticosteroids, and to start, if indicated, second-line therapy or \u201crescue therapy,\u201d such as calcineurin inhibitors (cyclosporine, tacrolimus) and anti\u2013tumor necrosis factor molecules (infliximab).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Several pitfalls may be present in the management of ASC, and a correct clinical and therapeutic approach is recommended to reduce surgical risk.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2015-1184","type":"journal-article","created":{"date-parts":[[2016,4,27]],"date-time":"2016-04-27T12:12:18Z","timestamp":1461759138000},"source":"Crossref","is-referenced-by-count":20,"title":["Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era"],"prefix":"10.1542","volume":"137","author":[{"given":"Claudio","family":"Romano","sequence":"first","affiliation":[{"name":"Inflammatory Bowel Disease Unit, Pediatric Department, University of Messina, Messina, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Syed","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Valenti","sequence":"additional","affiliation":[{"name":"Inflammatory Bowel Disease Unit, Pediatric Department, University of Messina, Messina, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subra","family":"Kugathasan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2016,5,1]]},"reference":[{"key":"2021120904335683400_B1","first-page":"713","author":"Cosnes","year":"2012"},{"issue":"10","key":"2021120904335683400_B2","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1111\/j.1365-2036.2011.04857.x","article-title":"Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease\u2014a population-based study.","volume":"34","author":"Jakobsen","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"issue":"3","key":"2021120904335683400_B3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1038\/ajg.2009.727","article-title":"Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee.","volume":"105","author":"Kornbluth","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"2021120904335683400_B4","article-title":"Kane S. 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