Ulcerative Colitis

Diagnosing ulcerative colitis involves a comprehensive evaluation combining medical history, physical examination, and various tests. These may include blood tests, stool studies, abdominal-pelvic computed tomography (CT), endoscopy, colonoscopy with biopsies, and other imaging studies. Through these tests, we can detect signs of inflammation, anemia, low protein levels, and rule out infections. These methods help identify active inflammation and assess the extent of disease throughout the digestive tract.

Because symptoms can be nonspecific, confirming a diagnosis may take time. In some cases, it can be challenging to distinguish ulcerative colitis from Crohn’s disease, another form of inflammatory bowel disease, a condition referred to as indeterminate colitis. 

The main goals of treating pediatric Ulcerative colitis are to control inflammation, relieve symptoms, promote growth and nutrition, and achieve long-term remission. Children are often treated with medications, and in some cases, surgery may be required if complications develop.

Traditionally, treatment has followed a “step-up” approach, starting with milder medications like corticosteroids and gradually introducing biologics if symptoms worsen or relapse occurs. However, in pediatric ulcerative colitis—where relapses are more frequent and the disease duration is longer than in adults—a “top-down” strategy is increasingly recommended. This approach involves starting biologic therapy early after diagnosis to provide intensive treatment from the outset. Early aggressive therapy is especially important in children, as inadequate treatment can negatively affect growth and lead to surgery later in life.

Common Medications for Ulcerative colitis

• 5-Aminosalicylic Acid (5-ASA): Taken orally or rectally to reduce inflammation in mild to moderate cases.
• Corticosteroids: Taken orally, rectally, or intravenously to quickly control inflammation in moderate to severe cases. While effective, corticosteroids are used for the shortest duration possible due to potential side effects such as acne, excessive hair growth, mood changes, increased appetite, facial swelling, and growth delay in children.
• Immunomodulators: Includes azathioprine and methotrexate (MTX). These medications are taken orally or by injection to suppress the immune system and reduce inflammation.
• Biologics: Administered by injection or infusion to block specific inflammatory pathways, especially in moderate to severe cases. Depending on the child’s condition or disease activity, the dosing interval and amount of biologics can be adjusted. Drug levels are regularly monitored to ensure they remain within the optimal therapeutic range.
• Antibiotics: Used as needed to reduce intestinal bacteria and manage related infections.

Even with proper medication and diet, some children with ulcerative colitis may require surgery to achieve the best possible quality of life. The decision for surgery is made through close collaboration between the child, family, gastroenterologist, and a surgeon specializing in IBD. Surgery is considered when medical treatment is no longer effective in controlling symptoms or supporting growth and weight gain. Unlike in Crohn’s disease, where surgery is often a temporary measure, surgery for ulcerative colitis can provide long-term relief.