Ulcerative colitis in children

Ulcerative colitis should be considered in children who present with both of the following:

bloody diarrhoea for more than 2 weeks
negative stool examination for bacterial pathogens (including Aeromonas species, Yersinia species and Clostridioides difficile [formerly known as Clostridium difficile]).

Assessment of a child with suspected ulcerative colitis includes full blood count; serum electrolyte, urea and creatinine concentration; liver biochemistry; C-reactive protein (CRP); and iron studies. Refer all children suspected of having ulcerative colitis to a paediatric gastroenterologist for consideration of a diagnostic gastroscopy and colonoscopy.

Management of ulcerative colitis in children may include a 5-aminosalicylate (sulfasalazine or mesalazine) and, in children with moderate to severe disease, a thiopurine (eg azathioprine) with or without a tumour necrosis factor (TNF) inhibitor. Induction therapy may include corticosteroids (eg budesonide, prednisolone, methylprednisolone)Turner, 2018.

Note: Children with acute severe colitis should be managed in a tertiary paediatric hospital.

Acute severe colitis is a medical emergency; it requires admission to a tertiary paediatric hospital and early specialist management by a multidisciplinary team. Initial management is with intravenous methylprednisolone. Prompt medical salvage therapy (eg tacrolimus, ciclosporin, infliximab) may be required for children with acute severe ulcerative colitis who do not respond or continue to deteriorate despite 3 days of intravenous methylprednisolone. Subtotal colectomy or ileostomy may be required for refractory diseaseTurner, 2018.