Optimal management of acute severe ulcerative colitis in children / 中华实用儿科临床杂志

Acute severe ulcerative colitis (ASUC) is one emergency in pediatric gastroenterology.The disease is serious, which may even endanger the life of patients.Close monitoring and timely pharmacological and surgical interventions are key measures to improve outcomes.Treatment methods for ASUC include necessary nutritional support, water and electrolyte disturbance correction, and possible concurrent bacterial or viral infection elimination.Patients at high risk require subcutaneous injections of low molecular weight heparin to prevent thrombosis.Intravenous cortico-steroids are the first-line treatment of ASUC.For patients showing insufficient response to corticosteroids after 3-5 days, rescue treatment with immunosuppressants or biological agents is needed.Meanwhile, the clinical symptoms, serum inflammatory indicators and albumin levels of the patients should be closely monitored.Patients who failed medical treatment should undergo timely colectomy to prevent serious complications.In this paper, a systematic review of literature and expert consensus was conducted to summarize the clinical evaluation and treatment methods of ASUC children at different stages, in order to standardize the clinical treatment of pediatric ASUC.

Evaluation of children with inflammatory bowel diseases / 中华实用儿科临床杂志

The clinical manifestations and endoscopic changes of inflammatory bowel disease (IBD) are complex and vary greatly according to the severity of the problem.The activity of the inflammatory bowel disease,macroscopic and microscopic features are closely related to disease progression and treatment response.The activity and the severity of IBD can be defined by pediatric ulcerative colitis activity index (PUCAI) and pediatric Crohn's disease activity index(PCDAI).According to the Montreal standards and Paris consensus,the extent of the endoscopic intestinal involvement and the severity of the lesion can be determined.It reflects the local changes before and after the treatment and reactions as time goes on.It's helpful to evaluate the severity and the treatment efficacy of IBD,to carry out multi-center and large-scale research through the activity score,macroscopic and microscopic features evaluation.

Failure of Fecal Microbiota Transplantation in a Three-Year-Old Child with Severe Refractory Ulcerative Colitis / 대한소아소화기영양학회지

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (×2) and via a nasoduodenal tube (×4) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.