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Management of Pediatric Patients Hospitalized with Ulcerative

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Management of Inpatient Inflammatory Bowel Disease

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Abstract

Children with severe ulcerative colitis, similarly adults, present with abdominal pain, bloody diarrhea, and sometimes anemia. The initial evaluation includes excluding infection such as C. difficile that may be causing colitis exacerbations and also ruling out toxic megacolon. Initial sigmoidoscopy with biopsy should be considered to evaluate disease severity and exclude cytomegalovirus infection. The pediatric ulcerative colitis activity index is a validated scoring system that can be utilized to track disease activity on a daily basis. Supportive care includes intravenous hydration and, if needed, blood transfusions to treat anemia and restore hemodynamic stability. The initial medical therapy for severe colitis involves intravenous corticosteroids. For corticosteroid-refractory patients, infliximab is our primary mainstay of therapy. Calcineurin inhibitors such as cyclosporine or tacrolimus are also effective in steroid-refractory ulcerative colitis. Given that many patients do not respond to these treatments, surgical consultation and discussion of the possibility of surgery with the family should be considered at an early stage.

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Author information

Authors and Affiliations

  1. Professor of Pediatrics, Harvard Medical School, Inflammatory Bowel Disease Center, Boston Children’s Hospital, Boston, MA, USA

    Athos Bousvaros

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  1. Athos Bousvaros
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Correspondence to Athos Bousvaros .

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Editors and Affiliations

  1. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Joseph D. Feuerstein

  2. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Adam S. Cheifetz

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Bousvaros, A. (2022). Management of Pediatric Patients Hospitalized with Ulcerative. In: Feuerstein, J.D., Cheifetz, A.S. (eds) Management of Inpatient Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-0716-1987-2_11

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  • DOI: https://doi.org/10.1007/978-1-0716-1987-2_11

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  • Online ISBN: 978-1-0716-1987-2

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