BACKGROUND AND AIM: Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. METHODS: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including 2 face-to-face meetings, was followed by voting of the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts). RESULTS: A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring, and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index. Several topics have been altered since the previous 2011 guidelines and from those published in adults. DISCUSSION: These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.

1st Department of Pediatrics Semmelweis University Budapest Hungary

Barts and the London School of Medicine Queen Mary University of London London UK

BC Children's Hospital University of British Columbia Vancouver BC Canada

Child Life and Health University of Edinburgh Edinburgh UK

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Woman Child and General and Specialistic Surgery University of Campania Luigi Vanvitelli Napoli Italy

Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

Helsinki University Children's Hospital Department of Pediatric Surgery Helsinki Finland

Hospital Sant Joan de Déu Barcelona Spain

Medical School and University Hospital of Ioannina Ioannina Greece

National Children's Research Centre Royal College of Surgeons of Ireland and University College Dublin Ireland

Pediatric Department University of Messina Messina Italy

Pediatric Gastroenterology and Liver Unit Sapienza University of Rome Rome

Pediatric Gastroenterology and Nutrition Unit Hospital Materno IBIMA Málaga Spain

Schneider Children's Hospital Petach Tikva Tel Aviv University Tel Aviv Israel

Shaare Zedek Medical Center The Hebrew University of Jerusalem Jerusalem Israel

Southampton Children's Hospital Southampton UK

The Hospital for Sick Children University of Toronto Toronto Canada

The Royal Hospital for Children Glasgow UK

Université Paris Descartes Sorbonne Paris Cité APHP Hôpital Necker Enfants Malades Paris France

University Children's Hospital Zurich Switzerland

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Thromboprophylaxis Use in Paediatric Inflammatory Bowel Disease: An International RAND Appropriateness Panel