Acute severe colitis (ASC) is a relatively frequent manifestation in children with ulcerative colitis and one of the few emergencies in paediatric gastroenterology. A standardized proactive approach based on tight monitoring and timely medical and surgical interventions may improve patients' outcomes. We aimed to update the previous ASC guidelines using detailed recommendations and practice points, based on a systematic review of the literature and consensus of experts. These guidelines update is a joint effort of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organization. A systematic search was performed in Pubmed Ovid Medline, Embase and Cochrane databases using 13 predefined PICO (patient, intervention, comparison, outcomes) based questions and 30 non-PICO based questions. Grading methodology was based on the Oxford Centre for Evidence-Based Medicine-Levels of evidence. The questions were addressed by working subgroups following an iterative consensus voting process, including three online voting meetings and one face-to-face meeting. A total of 36 recommendations and 72 practice points were endorsed with a consensus rate of at least 88% for all statements, regarding initial evaluation, monitoring, medical and surgical treatment of ASC in children. Several topics have been revised since the previous 2018 guidelines and differ from corresponding published adult guidelines. These guidelines present a comprehensive overview of the management of ASC in children, offering practical recommendations and practice points aiming to standardize clinical and surgical treatment and improve outcomes of this severe scenario.

Centro Hospitalar Universitário São João Pediatric Gastroenterology and Nutrition Unit Porto Portugal

Child Life and Health Centre for Inflammation Research University of Edinburgh Edinburgh UK

Colorectal Surgery Vall d'Hebron University Hospital Universitat Autònoma de Barcelona UAB Barcelona Spain

Department of Advanced Medical and Surgical Sciences Universitádegli Studi della Campania Luigi Vanvitelli Naples Italy

Department of Medicine Solna Division of Clinical Epidemiology Karolinska Institutet Stockholm Sweden

Department of Paediatric Gastroenterology Erasmus MC Sophia Children's Hospital Rotterdam the Netherlands

Department of Paediatric Gastroenterology Hepatology and Nutrition University Medical Center Groningen University of Groningen Groningen the Netherlands

Department of Paediatric Gastroenterology Jenny Lind Children's Hospital Norfolk and Norwich University Hospitals Faculty of Medicine and Health Science University of East Anglia Norwich UK

Department of Paediatric Gastroenterology Royal Hospital for Children and Young People Edinburgh UK

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Paediatrics Vittore Buzzi Children's Hospital University of Milan Milan Italy

Department of Pediatric Gastroenterology Hepatology and Nutrition Hospital Sant Joan de Déu Barcelona Spain

Department of Pediatrics Division of Pediatric Gastroenterology University of Alberta Edmonton Alberta Canada

Department of Translational Medical Science Section of Paediatrics University of Naples Federico 2 Naples Italy

Division of Gastroenterology Hepatology and Nutrition Hospital for Sick Children Toronto Ontario Canada

Division of Paediatric Gastroenterology and Nutrition Emma Children's Hospital Amsterdam UMC Amsterdam the Netherlands

DOCHAS Group Children's Health Ireland University College Dublin Dublin Ireland

Institute of Gastroenterology Nutrition and Liver Diseases Schneider Children's Medical Center of Israel Petah Tikva and the Faculty of Medicine Tel Aviv University Tel Aviv Israel

Pediatric Department Vittore Buzzi Children's Hospital University of Milan Milan Italy

Pediatric Gastroenterology Ghent University Hospital Ghent Belgium

Pediatric Gastroenterology Hepatology and Cystic Fibrosis Unit Department of Pathophysiology and Transplantation University of Milan Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano Milan Italy

Pediatric Gastroenterology Institute Dana Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel and the Faculty of Medical and Health Sciences Tel Aviv University Tel Aviv Israel

Referral Center for Pediatric Gastroenterology and Nutrition Department of Pediatrics Children's Hospital Zagreb University of Zagreb Medical School Zagreb Croatia

The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition Eisenberg R and D Authority Shaare Zedek Medical Centre The Hebrew University Jerusalem Israel

Translational Gastroenterology Unit John Radcliffe Hospital Oxford University Hospitals NHS Trust Oxford UK

University of Toronto Toronto Ontario Canada

Zobrazit více v PubMed

Assa A, Rinawi F, Shamir R. The long‐term predictive properties of the Paris classification in paediatric inflammatory bowel disease patients. J Crohn's Col. 2018;12:39‐47.

Gros B, Kaplan GG. Ulcerative colitis in adults: a review. JAMA. 2023;330:951‐965.

Van Limbergen J, Russell RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood‐onset inflammatory bowel disease. Gastroenterology. 2008;135:1114‐1122.

Jakobsen C, Bartek Jr. J, Wewer V, et al. Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease—a population‐based study. Aliment Pharmacol Ther. 2011;34:1217‐1224.

Turner D, Ruemmele FM, Orlanski‐Meyer E, et al. Management of paediatric ulcerative colitis, part 2: acute severe colitis‐an evidence‐based consensus guideline from the European Crohn's and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018;67:292‐310.

Turner D, Otley AR, Mack D, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007;133:423‐432.

Aloi M, Bramuzzo M, Norsa L, et al. Disease activity patterns in the first 5 years after diagnosis in children with ulcerative colitis: a population‐based study. J Crohn's Col. 2021;15:367‐374.

Atia O, Klomberg RCW, de Ridder L, et al. Validation of predictive models for disease outcomes in paediatric ulcerative colitis: a multicentre prospective inception cohort. Aliment Pharmacol Ther. 2023;58:182‐190.

Dhaliwal J, Tertigas D, Carman N, et al. Outcomes following acute severe colitis at initial presentation: a multi‐centre, prospective, paediatric cohort study. J Crohn's Col. 2024;18:233‐245.

Hyams JS, Davis Thomas S, Gotman N, et al. Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort study. Lancet. 2019;393:1708‐1720.

Krauthammer A, Tzivinikos C, Assa A, et al. Long‐term outcomes of paediatric patients admitted with acute severe colitis: a multicentre study from the Paediatric IBD Porto Group of ESPGHAN. J Crohn's Col. 2019;13:1518‐1526.

Claßen, M, Schiller B, Däbritz J, et al. Predicting complications in paediatric ulcerative colitis: a longitudinal multicentre cohort study. Aliment Pharmacol Ther. 2024;60:1421‐1434.

Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta‐regression. Clin Gastroenterol Hepatol. 2007;5:103‐110.

Calméjane L, Laharie D, Kirchgesner J, Uzzan M. Review article: updated management of acute severe ulcerative colitis: from steroids to novel medical strategies. United European Gastroenterol J. 2023;11:722‐732.

Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1‐s106.

Orlanski‐Meyer E, Aardoom M, Ricciuto A, et al. Predicting outcomes in pediatric ulcerative colitis for management optimization: systematic review and consensus statements from the pediatric inflammatory bowel disease‐ahead program. Gastroenterology. 2021;160:378‐402.e22.

Turner D, Travis SPL, Griffiths AM, et al. Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN. Am J Gastroenterol. 2011;106:574‐588.

Ludvigsson JF, Sachs MC, Järås J, Malmborg P, Olén O. Serious infections in pediatric inflammatory bowel disease 2002‐2017: a nationwide cohort study. J Pediatr. 2021;238:66‐73.e1.

Russell RK, Protheroe A, Roughton M, et al. Contemporary outcomes for ulcerative colitis inpatients admitted to pediatric hospitals in the United Kingdom. Inflamm Bowel Dis. 2013;19:1434‐1440.

Ihekweazu FD, Ajjarapu A, Kellermayer R. Diagnostic yield of routine enteropathogenic stool tests in pediatric ulcerative colitis. Ann Clin Lab Sci. 2015;45:639‐642.

Pascarella F, Martinelli M, Miele E, Del Pezzo M, Roscetto E, Staiano A. Impact of Clostridium difficile infection on pediatric inflammatory bowel disease. J Pediatr. 2009;154:854‐858.

Pant C, Anderson MP, Deshpande A, et al. Health care burden of Clostridium difficile infection in hospitalized children with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(5):1080‐1085.

Mezoff E, Mann EA, Hart KW, Lindsell CJ, Cohen MB. Clostridium difficile infection and treatment in the pediatric inflammatory bowel disease population. J Pediatr Gastroenterol Nutr. 2011;52:437‐441.

Hourigan SK, Oliva‐Hemker M, Hutfless S. The prevalence of Clostridium difficile infection in pediatric and adult patients with inflammatory bowel disease. Dig Dis Sci. 2014;59:2222‐2227.

Hourigan SK, Chirumamilla SR, Ross T, et al. Clostridium difficile carriage and serum antitoxin responses in children with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:2744‐2752.

Banaszkiewicz A, Kowalska‐Duplaga K, Pytrus T, Pituch H, Radzikowski A. Clostridium difficile infection in newly diagnosed pediatric patients with inflammatory bowel disease: prevalence and risk factors. Inflamm Bowel Dis. 2012;18:844‐848.

Chandrakumar A, Zohni H, El‐Matary W. Clostridioides difficile infection in children with inflammatory bowel disease. Inflamm Bowel Dis. 2020;26:1700‐1706.

El‐Matary W, Nugent Z, Yu BN, et al. Trends and predictors of Clostridium difficile infection among children: a Canadian population‐based study. J Pediatr. 2019;206:20‐25.

Martinelli M, Strisciuglio C, Veres G, et al. Clostridium difficile and pediatric inflammatory bowel disease: a prospective, comparative, multicenter, ESPGHAN study. Inflamm Bowel Dis. 2014;20:2219‐2225.

Kuenzig ME, Benchimol EI, Bernstein CN, et al. Hospitalization with Clostridioides difficile in pediatric inflammatory bowel disease: a population‐based study. J Pediatr Gastroenterol Nutr. 2022;75:173‐180.

Fu N, Wong T. Clostridium difficile infection in patients with inflammatory bowel disease. Curr Infect Dis Rep. 2016;18:19.

Ricciardi R, Ogilvie Jr. JW, Roberts PL, Marcello PW, Concannon TW, Baxter NN. Epidemiology of Clostridium difficile colitis in hospitalized patients with inflammatory bowel diseases. Dis Colon Rect. 2009;52:40‐45.

Nguyen GC, Kaplan GG, Harris ML, Brant SR. A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103:1443‐1450.

Ananthakrishnan AN, McGinley EL, Saeian K, Binion DG. Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:976‐983.

Rodemann JF, Dubberke ER, Reske KA, Seo DH, Stone CD. Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007;5:339‐344.

Jen MH, Saxena S, Bottle A, Aylin P, Pollok RCG. Increased health burden associated with Clostridium difficile diarrhoea in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33:1322‐1331.

Murthy SK, Steinhart AH, Tinmouth J, Austin PC, Daneman N, Nguyen GC. Impact of Clostridium difficile colitis on 5‐year health outcomes in patients with ulcerative colitis. Aliment Pharmacol Ther. 2012;36:1032‐1039.

Berg AM, Kelly CP, Farraye FA. Clostridium difficile infection in the inflammatory bowel disease patient. Inflamm Bowel Dis. 2013;19:194‐204.

Issa M, Ananthakrishnan AN, Binion DG. Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis. 2008;14:1432‐1442.

Conrad MA, Kelsen JR. Clostridioides difficile infection in pediatric inflammatory bowel disease: a Clinician's dilemma. J Pediatric Infect Dis Soc. 2021;10:S41‐S45.

McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66:987‐994.

Carey‐Ann BD, Carroll KC. Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev. 2013;26:604‐630.

Eastwood K, Else P, Charlett A, Wilcox M. Comparison of nine commercially available Clostridium difficile toxin detection assays, a real‐time PCR assay for C. difficile tcdB, and a glutamate dehydrogenase detection assay to cytotoxin testing and cytotoxigenic culture methods. J Clin Microbiol. 2009;47:3211‐3217.

Planche T, Aghaizu A, Holliman R, et al. Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review. Lancet Infect Dis. 2008;8:777‐784.

Gawronska A, Banasiuk M, Lachowicz D, Pituch H, Albrecht P, Banaszkiewicz A. Metronidazole or rifaximin for treatment of Clostridium difficile in pediatric patients with inflammatory bowel disease: a randomized clinical trial. Inflamm Bowel Dis. 2017;23:2209‐2214.

Johnson S, Louie TJ, Gerding DN, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345‐354.

Wolf J, Kalocsai K, Fortuny C, et al. Safety and efficacy of fidaxomicin and vancomycin in children and adolescents with Clostridioides (Clostridium) difficile infection: a phase 3, multicenter, randomized, single‐blind clinical trial (SUNSHINE). Clin Infect Dis. 2020;71:2581‐2588.

Khoruts A, Rank KM, Newman KM, et al. Inflammatory bowel disease affects the outcome of fecal microbiota transplantation for recurrent Clostridium difficile infection. Clin Gastroenterol Hepatol. 2016;14:1433‐1438.

DeFilipp Z, Bloom PP, Torres Soto M, et al. Drug‐resistant E. coli bacteremia transmitted by fecal microbiota transplant. N Engl J Med. 2019;381:2043‐2050.

Lawlor G, Moss AC. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflamm Bowel Dis. 2010;16:1620‐1627.

Temtem T, Whitworth J, Zhang J, Bagga B. Cytomegalovirus in pediatric inflammatory bowel disease patients with acute severe colitis. Clin Res Hepatol Gastroenterol. 2021;45:101625.

Cohen S, Martinez‐Vinson C, Aloi M, et al. Cytomegalovirus infection in pediatric severe ulcerative colitis: a multicenter study from the Pediatric Inflammatory Bowel Disease Porto Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. Pediatr Infect Dis J. 2018;37:197‐201.

Yerushalmy‐Feler A, Kern‐Isaacs S, Cohen S. CMV infection in pediatric IBD. Curr Gastroenterol Rep. 2018;20:13.

Tandon P, James P, Cordeiro E, Mallick R, Shukla T, McCurdy JD. Diagnostic accuracy of blood‐based tests and histopathology for cytomegalovirus reactivation in inflammatory bowel disease: a systematic review and meta‐analysis. Inflamm Bowel Dis. 2017;23:551‐560.

Sebastián‐Planas M, Barrio‐Merino A, Avilla‐Hernandez J, et al. Cytomegalovirus infection of the colon in ulcerative colitis: a pediatric case. J Pediatr Gastroenterol Nutr. 1996;23:186‐190.

Shukla T, Singh S, Loftus Jr. EV, Bruining DH, McCurdy JD. Antiviral therapy in steroid‐refractory ulcerative colitis with cytomegalovirus: systematic review and meta‐analysis. Inflamm Bowel Dis. 2015;21:2718‐2725.

Vadlamudi NBHM, Hitch MC, Thame KA, et al. Enteric infections in hospitalized pediatric inflammatory bowel disease patients with relapse. Internet J Paediatr Neonatol. 2013;16:1‐7.

Khan RR, Lawson AD, Minnich LL, et al. Gastrointestinal norovirus infection associated with exacerbation of inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009;48:328‐333.

Vadlamudi N, Maclin J, Dimmitt RA, Thame KA. Cryptosporidial infection in children with inflammatory bowel disease. J Crohn's Col. 2013;7:e337‐e343.

Desai J, Elnaggar M, Hanfy AA, et al. Toxic megacolon: background, pathophysiology, management challenges and solutions. Clin Exp Gastroenterol. 2020;13:203‐210.

Benchimol EI, Turner D, Mann EH, et al. Toxic megacolon in children with inflammatory bowel disease: clinical and radiographic characteristics. Am J Gastroenterol. 2008;103:1524‐1531.

de Groof EJ, Carbonnel F, Buskens CJ, Bemelman WA. Abdominal abscess in Crohn's disease: multidisciplinary management. Dig Dis. 2014;32(suppl 1):103‐109.

Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML. Medical decompression of toxic megacolon by “rolling”. A new technique of decompression with favorable long‐term follow‐up. J Clin Gastroenterol. 1988;10:485‐490.

Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee‐elbow position relieves bowel distension. Gut. 1993;34:1726‐1727.

Okano S, Sako M, Yoshimura N, Takazoe M. [Three cases of severe and fulminating ulcerative colitis with megacolon treated with continuous intravenous infusion of cyclosporine]. Nihon Shokakibyo Gakkai zasshi = Japan J Gastro‐Enterol. 2020;117:157‐164.

Pascu M, Müller HP, Müller AR, Wiedenmann B, Dignass AU. Rescue therapy with tacrolimus in a patient with toxic megacolon. Int J Colorectal Dis. 2003;18:271‐275.

Narabayashi K, Inoue T, Sakanaka T, et al. Oral tacrolimus for megacolon in patients with severe ulcerative colitis. Intern Med. 2014;53:1755‐1758.

Sawada K, Egashira A, Ohnishi K, Fukunaga K, Kusaka T, Shimoyama T. Leukocytapheresis (LCAP) for management of fulminant ulcerative colitis with toxic megacolon. Dig Dis Sci. 2005;50:767‐773.

Knroki K, Masuda A, Uehara H, Kuroki A. A new treatment for toxic megacolon. Lancet. 1998;352:782.

Castro Fernández M, García Romero D, Sánchez Muñoz D, Grande L, Larraona JL. [Severe ulcerative colitis, with toxic megacolon, resolved with infliximab therapy]. Rev Esp Enferm Dig. 2007;99:426‐427.

Mishra S, Jha DK, Singh AK, Kumar‐M P, Patil A, Sharma V. Antibiotics for induction and maintenance of remission in ulcerative colitis: systematic review and meta‐analysis. Expert Rev Gastroenterol Hepatol. 2021;15:1215‐1223.

Chapman RW, Selby WS, Jewell DP. Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis. Gut. 1986;27:1210‐1212.

Mantzaris GJ, Hatzis A, Kontogiannis P, Triadaphyllou G. Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol. 1994;89:43‐46.

Mantzaris GJ, Petraki K, Archavlis E, et al. A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Scand J Gastroenterol. 2001;36:971‐974.

Mishra S, Mandavdhare HS, Singh H, et al. Adjuvant use of combination of antibiotics in acute severe ulcerative colitis: a placebo controlled randomized trial. Expert Rev Anti Infect Ther. 2021;19:949‐955.

Turner D, Bishai J, Reshef L, et al. Antibiotic cocktail for pediatric acute severe colitis and the microbiome: the PRASCO randomized controlled trial. Inflamm Bowel Dis. 2020;26:1733‐1742.

Harbord M, Eliakim R, Bettenworth D, et al. Third European evidence‐based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohn's Col. 2017;11:769‐784.

Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114:384‐413.

Turner D, Levine A, Kolho KL, Shaoul R, Ledder O. Combination of oral antibiotics may be effective in severe pediatric ulcerative colitis: a preliminary report. J Crohn's Col. 2014;8:1464‐1470.

Burr NE, Smith C, West R, Hull MA, Subramanian V. Increasing prescription of opiates and mortality in patients with inflammatory bowel diseases in England. Clin Gastroenterol Hepatol. 2018;16:534‐541.e6.

Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infection and mortality in patients with Crohn's disease: more than 5 years of follow‐up in the TREAT™ registry. Am J Gastroenterol. 2012;107:1409‐1422.

Dalal RS, Lund K, Zegers FD, et al. Use of tramadol vs traditional opioids and adverse outcomes in patients with inflammatory bowel disease: a Danish nationwide cohort study. Inflamm Bowel Dis. 2024;30:1121‐1129.

Felder JB, Korelitz BI, Rajapakse R, Schwarz S, Horatagis AP, Gleim G. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case‐control study. Am J Gastroenterol. 2000;95:1949‐1954.

Magro F, Gionchetti P, Eliakim R, et al. Third European evidence‐based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra‐intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo‐anal pouch disorders. J Crohn's Col. 2017;11:649‐670.

Moninuola OO, Milligan W, Lochhead P, Khalili H. Systematic review with meta‐analysis: association between acetaminophen and nonsteroidal anti‐inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation. Aliment Pharmacol Ther. 2018;47:1428‐1439.

White M, Shah N, Lindley K, Lloyd‐Thomas A, Thomas M. Pain management in fulminating ulcerative colitis. Pediatr Anesth. 2006;16:1148‐1152.

Vinci A, Ingravalle F, Bardhi D, et al. Cannabinoid therapeutic effects in inflammatory bowel diseases: asystematic review and meta‐analysis of randomized controlled trials. Biomedicines. 2022;10:2439.

Hojsak I, Pavić AM, Kolaček S. Mesalamine treatment mimicking relapse in a child with ulcerative colitis. World J Pediatr. 2014;10:371‐373.

Iofel E, Chawla A, Daum F, et al. Mesalamine intolerance mimics symptoms of active inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;34:73‐76.

Loftus Jr. EV, Kane SV, Bjorkman D. Short‐term adverse effects of 5‐aminosalicylic acid agents in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2004;19:179‐189.

Ben‐Horin S, Har‐Noy O, Katsanos KH, et al. P312 combination corticosteroids with, 5‐aminosalicylic acid versus corticosteroids alone in the treatment of hospitalized patients with acute severe ulcerative colitis: a multi‐center randomized controlled trial. J Crohn's Colitis. 2022;16:i337.

González‐Huix F, Fernández‐Bañares F, Esteve‐Comas M, et al. Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis. Am J Gastroenterol. 1993;88:227‐232.

Barabino A, egaldo L, Castellano E, et al. Severe attack of ulcerative colitis in children: retrospective clinical survey. Dig Liver Dis. 2002;34:44‐49.

Turner D, Mack D, Leleiko N, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response. Gastroenterology. 2010;138:2282‐2291.

Sahu P, Kedia S, Vuyyuru SK, et al. Randomised clinical trial: exclusive enteral nutrition versus standard of care for acute severe ulcerative colitis. Aliment Pharmacol Ther. 2021;53:568‐576.

Chien KA, Cooley V, Prishtina F, Grinspan ZM, Gerber LM, Kucine N. Health and financial burdens associated with venous thrombosis in hospitalized children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2021;72(5):748‐751.

Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(9):2272‐2280.

Zitomersky NL, Levine AE, Atkinson BJ, et al. Risk factors, morbidity, and treatment of thrombosis in children and young adults with active inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;57:343‐347.

Aardoom MA, Klomberg RCW, Kemos P, et al. The incidence and characteristics of venous thromboembolisms in paediatric‐onset inflammatory bowel disease: a prospective international cohort study based on the PIBD‐SETQuality safety registry. J Crohn's Col. 2022;16:695‐707.

Kuenzig ME, Bitton A, Carroll MW, et al. Inflammatory bowel disease increases the risk of venous thromboembolism in children: a population‐based matched cohort study. J Crohn's Col. 2021;15:2031‐2040.

Kappelman MD, Horvath‐Puho E, Sandler RS, et al. Thromboembolic risk among Danish children and adults with inflammatory bowel diseases: a population‐based nationwide study. Gut. 2011;60(7):937‐943.

De Laffolie J, Ballauff A, Wirth S, et al. Occurrence of thromboembolism in paediatric patients with inflammatory bowel disease: data from the CEDATA‐GPGE registry. Front Pediatr. 2022;10:883183.

Klomberg RCW, Hellendoorn AE, Kemos P, et al. Rare and severe adverse events in children with inflammatory bowel disease: analysis of data from the PIBD‐SETQuality safety registry. Lancet Child Adolesc Health. 2024;8(6):422‐432.

Gandhi J, Mages K, Kucine N, Chien K. Venous thromboembolism in pediatric inflammatory bowel disease: a scoping review. J Pediatr Gastroenterol Nutr. 2023;77(4):491‐498.

Lagrange J, Lacolley P, Wahl D, Peyrin‐Biroulet L, Regnault V. Shedding light on hemostasis in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2021;19:1088‐1097.e6.

Danese S, Papa A, Saibeni S, Repici A, Malesci A, Vecchi M. Inflammation and coagulation in inflammatory bowel disease: the clot thickens. Am J Gastroenterol. 2007;102(1):174‐186.

Alkim H, Koksal AR, Boga S, Sen I, Alkim C. Etiopathogenesis, prevention, and treatment of thromboembolism in inflammatory bowel disease. Clin Appl Thromb Hemost. 2017;23:501‐510.

Ding Z, Sherlock M, Chan AKC, Zachos M. Venous thromboembolism in pediatric inflammatory bowel disease: an 11‐year population‐based nested case‐control study in Canada. Blood Coagulat Fibrinolysis Int J Haemostasis Thromb. 2022;33(8):449‐456.

Nylund CM, Goudie A, Garza JM, Crouch G, Denson LA. Venous thrombotic events in hospitalized children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;56:485‐491.

Mitchel EB, Rosenbaum S, Gaeta C, et al. Venous thromboembolism in pediatric inflammatory bowel disease: a case‐control study. J Pediatr Gastroenterol Nutr. 2021;72(5):742‐747.

Sarlos P, Szemes K, Hegyi P, et al. Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease: a meta‐analysis. J Crohn's Col. 2018;12:489‐498.

Higgins PDR, Skup M, Mulani PM, Lin J, Chao J. Increased risk of venous thromboembolic events with corticosteroid vs biologic therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2015;13(2):316‐321.

Székely H, Tóth LM, Rancz A, et al. Anti‐tumor necrosis factor alpha versus corticosteroids: a 3‐fold difference in the occurrence of venous thromboembolism in inflammatory bowel disease: a systematic review and meta‐analysis. J Crohn's Col. 2024;18:773‐783.

Bence CM, Traynor MD, Polites SF, et al. The incidence of venous thromboembolism in children following colorectal resection for inflammatory bowel disease: a multi‐center study. J Pediatr Surg. 2020;55(11):2387‐2392.

Barclay AR, Keightley JM, Horrocks I, Garrick V, McGrogan P, Russell RK. Cerebral thromboembolic events in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2010;16(4):677‐683.

Rohani P, Taraghikhah N, Nasehi MM, Alimadadi H, Assadzadeh Aghdaei H. Cerebrovascular events in pediatric inflammatory bowel disease: a review of published cases. Pediatr Gastroenterol Hepatol Nutr. 2022;25:180‐193.

Harvey PR, McNulty D, Coupland B, et al. The risk of venous thromboembolism in children with inflammatory bowel disease. Inflamm Bowel Dis. 2024:izae249. doi:10.1093/ibd/izae249

Morgan J, Checketts M, Arana A, et al. Prevention of perioperative venous thromboembolism in pediatric patients: guidelines from the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). Paediatr Anaesth. 2018;28(5):382‐391.

Molinari AC, Banov L, Bertamino M, Barabino P, Lassandro G, Giordano P. A practical approach to the use of low molecular weight heparins in VTE treatment and prophylaxis in children and newborns. Pediatr Hematol Oncol. 2015;32(1):1‐10.

Klaassen ILM, Sol JJ, Suijker MH, Fijnvandraat K, van de Wetering MD, Heleen van Ommen C. Are low‐molecular‐weight heparins safe and effective in children? A systematic review. Blood Rev. 2019;33:33‐42.

Story E, Bijelic V, Penney C, Benchimol EI, Halton J, Mack DR. Safety of venous thromboprophylaxis with low‐molecular‐weight heparin in children with ulcerative colitis. J Pediatr Gastroenterol Nutr. 2021;73:604‐609.

Kaddourah O. Venous thromboembolism prophylaxis in inflammatory bowel disease flare‐ups. Ann Gastroenterol. 2019;32:578‐583.

Ra G, Thanabalan R, Ratneswaran S, Nguyen GC. Predictors and safety of venous thromboembolism prophylaxis among hospitalized inflammatory bowel disease patients. J Crohn's Col. 2013;7:e479‐e485.

Diamond CE, Hennessey C, Meldau J, et al. Catheter‐related venous thrombosis in hospitalized pediatric patients with inflammatory bowel disease: incidence, characteristics, and role of anticoagulant thromboprophylaxis with enoxaparin. J Pediatr. 2018;198:53‐59.

Samama MM, Cohen AT, Darmon J‐Y, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med. 1999;341:793‐800.

Mismetti P, Laporte‐Simitsidis S, Tardy B, et al. Prevention of venous thromboembolism in internal medicine with unfractionated or low‐molecular‐weight heparins: a meta‐analysis of randomised clinical trials. Thromb Haemost. 2000;83:14‐19.

Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta‐analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146(4):278‐288.

Fernando SM, Tran A, Cheng W, et al. VTE prophylaxis in critically ill adults. Chest. 2022;161(2):418‐428.

Ananthakrishnan AN, Cagan A, Gainer VS, et al. Thromboprophylaxis is associated with reduced post‐hospitalization venous thromboembolic events in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2014;12:1905‐1910.

McKie K, McLoughlin RJ, Hirsh MP, Cleary MA, Aidlen JT. Risk factors for venous thromboembolism in children and young adults with inflammatory bowel disease. J Surg Res. 2019;243:173‐179.

Egberg MD, Galanko JA, Barnes EL, Kappelman MD. Thrombotic and infectious risks of parenteral nutrition in hospitalized pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2019;25:601‐609.

McNeil R, Fredman D, Eldar O, Gafter‐Gvili A, Avni T. Venous thromboembolism prophylaxis in inflammatory bowel disease inpatients: systematic review and meta‐analysis. Acta Haematol. 2024;147:702‐715.

Gordon H, Burisch J, Ellul P, et al. ECCO guidelines on extraintestinal manifestations in inflammatory bowel disease. J Crohn's Col. 2024;18:1‐37.

Olivera PA, Zuily S, Kotze PG, et al. International consensus on the prevention of venous and arterial thrombotic events in patients with inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:857‐873.

Chien KA, Hammad HT, Gerber L, Sheth S, Sockolow R, Kucine N. Pediatric gastroenterologists’ approach to venous thromboembolism prophylaxis in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2018;66:286‐288.

Turner D, Walsh CM, Benchimol EI, et al. Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second‐line therapy. Gut. 2008;57(3):331‐338.

Turner D, Griffiths AM. Acute severe ulcerative colitis in children: a systematic review. Inflamm Bowel Dis. 2011;17:440‐449.

Turner D, Mack D, Leleiko N, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response. Gastroenterology. 2010;138:2282‐2291.

Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta‐regression. Clin Gastroenterol Hepatol. 2007;5(1):103‐110.

Choshen S, Finnamore H, Auth MKH, et al. Corticosteroid dosing in pediatric acute severe ulcerative colitis. J Pediatr Gastroenterol Nutr. 2016;63:58‐64.

Kudo T, Nagata S, Ohtani K, et al. Pulse steroids as induction therapy for children with ulcerative colitis. Pediatr Int. 2011;53(6):974‐979.

Rosenberg W, Ireland A, Jewell DP. High‐dose methylprednisolone in the treatment of active ulcerative colitis. J Clin Gastroenterol. 1990;12(1):40‐41.

Vora R, Finnamore HE, Crook K, et al. Clinical experience of use of high‐dose intravenous methylprednisolone in children with acute moderate to severe colitis. J Pediatr Gastroenterol Nutr. 2016;63:51‐57.

Broersen LH, Pereira AM, Jørgensen JO, Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and meta‐analysis. J Clin Endocrinol Metab. 2015;100:2171‐2180.

Younes AK, Younes NK. Recovery of steroid induced adrenal insufficiency. Transl Pediatr. 2017;6:269‐273.

Baker E. Is there a safe and effective way to wean patients off long‐term glucocorticoids? Br J Clin Pharmacol. 2021;87:12‐22.

Alves C, Robazzi TCV, Mendonça M. Withdrawal from glucocorticosteroid therapy: clinical practice recommendations. J Pediatr. 2008;84:192‐202.

Akahoshi S, Hasegawa Y. Steroid‐induced iatrogenic adrenal insufficiency in children: a literature review. Endocrines. 2020;1:125‐137.

Ahmet A, Rowan‐Legg A, Pancer L. Adrenal suppression from exogenous glucocorticoids: recognizing risk factors and preventing morbidity. Paediatr Child Health. 2021;26:242‐254.

Joseph RM, Hunter AL, Ray DW, Dixon WG. Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Semin Arthritis Rheum. 2016;46(1):133‐141.

Newell‐Price JDC, Auchus RJ. The adrenal cortex. Division E‐HS Williams Textbook of Endocrinology. 2nd ed. Elsevier; 2019:480‐541.

Kim MJ, Kim E, Kang B, Choe YH. Infliximab therapy for children with moderate to severe ulcerative colitis: a step‐up versus a top‐down strategy. Yonsei Med J. 2021;62:608.

Eronen H, Ilus T, Jussila A, Huhtala H, Collin P, Oksanen P. Long‐term outcome of patients with acute ulcerative colitis after first course of intravenous corticosteroids. Scand J Gastroenterol. 2021;56:234‐238.

Jeon HH. Clinical outcomes and predictive factors in oral corticosteroid‐refractory active ulcerative colitis. World J Gastroenterol. 2013;19(2):265‐273.

Barnes A, Spizzo P, Mountifield R. Corticosteroid exposure prior to admission and predicting need for rescue therapy in acute severe ulcerative colitis. Intern Med J. 2022;52(5):828‐833.

Ben‐Horin S, Har‐Noy O, Katsanos KH, et al. Corticosteroids and mesalamine versus corticosteroids for acute severe ulcerative colitis: a randomized controlled trial. Clin Gastroenterol Hepatol. 2022;20(12):2868‐2875.e1.

Turner D, Griffiths AM. Acute severe ulcerative colitis in children: a systematic review. Inflamm Bowel Dis. 2011;17:440‐449.

Hyams JS, Lerer T, Griffiths A, et al. Outcome following infliximab therapy in children with ulcerative colitis. Am J Gastroenterol. 2010;105:1430‐1436.

Brandse JF, van den Brink GR, Wildenberg ME, et al. Loss of infliximab into feces is associated with lack of response to therapy in patients with severe ulcerative colitis. Gastroenterology. 2015;149:350‐355.e2.

Irving PM, Gecse KB. Optimizing therapies using therapeutic drug monitoring: current strategies and future perspectives. Gastroenterology. 2022;162:1512‐1524.

Yarur AJ, Jain A, Sussman DA, et al. The association of tissue anti‐TNF drug levels with serological and endoscopic disease activity in inflammatory bowel disease: the ATLAS study. Gut. 2016;65:249‐255.

Brandse JF, Mathôt RA, van der Kleij D, et al. Pharmacokinetic features and presence of antidrug antibodies associate with response to infliximab induction therapy in patients with moderate to severe ulcerative colitis. Clin Gastroenterol Hepatol. 2016;14(2):251‐258.e2.

Dotan I, Ron Y, Yanai H, et al. Patient factors that increase infliximab clearance and shorten half‐life in inflammatory bowel disease: a population pharmacokinetic study. Inflamm Bowel Dis. 2014;20:2247‐2259.

Bar‐Yoseph H, Pressman S, Blatt A, et al. Infliximab‐tumor necrosis factor complexes elicit formation of anti‐drug antibodies. Gastroenterology. 2019;157:1338‐1351.e8.

Jongsma MME, Winter DA, Huynh HQ, et al. Infliximab in young paediatric IBD patients: it is all about the dosing. Eur J Pediatr. 2020;179:1935‐1944.

Chung A, Carroll M, Almeida P, et al. Early infliximab clearance predicts remission in children with Crohn's disease. Dig Dis Sci. 2023;68:1995‐2005.

Assa A, Dorfman L, Shouval DS, Shamir R, Cohen S. Therapeutic drug monitoring‐guided high‐dose infliximab for infantile‐onset inflammatory bowel disease: a case series. J Pediatr Gastroenterol Nutr. 2020;71:516‐520.

Ungar B, Mazor Y, Weisshof R, et al. Induction infliximab levels among patients with acute severe ulcerative colitis compared with patients with moderately severe ulcerative colitis. Aliment Pharmacol Ther. 2016;43:1293‐1299.

Papamichael K, Rivals‐Lerebours O, Billiet T, et al. Long‐term outcome of patients with ulcerative colitis and primary non‐response to infliximab. J Crohn's Col. 2016;10:1015‐1023.

Whaley KG, Xiong Y, Karns R, et al. Multicenter cohort study of infliximab pharmacokinetics and therapy response in pediatric acute severe ulcerative colitis. Clin Gastroenterol Hepatol. 2023;21:1338‐1347.

Gibson DJ, Heetun ZS, Redmond CE, et al. An accelerated infliximab induction regimen reduces the need for early colectomy in patients with acute severe ulcerative colitis. Clin Gastroenterol Hepatol. 2015;13:330‐335.e1.

Sebastian S, Myers S, Argyriou K, et al. Infliximab induction regimens in steroid‐refractory acute severe colitis: a multicentre retrospective cohort study with propensity score analysis. Aliment Pharmacol Ther. 2019;50:675‐683.

Gibson DJ, Doherty J, McNally M, et al. Comparison of medium to long‐term outcomes of acute severe ulcerative colitis patients receiving accelerated and standard infliximab induction. Frontline Gastroenterol. 2020;11:441‐447.

Nalagatla N, Falloon K, Tran G, et al. Effect of accelerated infliximab induction on short‐ and long‐term outcomes of acute severe ulcerative colitis: a retrospective multicenter study and meta‐analysis. Clin Gastroenterol Hepatol. 2019;17:502‐509.e1.

Govani SM, Berinstein JA, Waljee AK, Stidham RW, Higgins PDR, Hardiman KM. Use of accelerated induction strategy of infliximab for ulcerative colitis in hospitalized patients at a tertiary care center. Dig Dis Sci. 2020;65:1800‐1805.

Kosaraju RS, Wong DJ, Roth EM, et al. Dose‐intensified infliximab rescue therapy for severe ulcerative colitis does not reduce short‐term colectomy rates or increase postoperative complications. Dis Colon Rect. 2022;65:1232‐1240.

Shah SC, Naymagon S, Panchal HJ, Sands BE, Cohen BL, Dubinsky MC. Accelerated infliximab dosing increases 30‐day colectomy in hospitalized ulcerative colitis patients: a propensity score analysis. Inflamm Bowel Dis. 2018;24:651‐659.

Sebastian S, Myers S, Nadir S, Subramanian S. Systematic review: efficacy and safety of accelerated induction regimes in infliximab rescue therapy for hospitalized patients with acute severe colitis. Dig Dis Sci. 2019;64:1119‐1128.

Choy MC, Seah D, Faleck DM, et al. Systematic review and meta‐analysis: optimal salvage therapy in acute severe ulcerative colitis. Inflamm Bowel Dis. 2019;25:1169‐1186.

Srinivasan A, De Cruz P, Sam M, Toong C, van Langenberg DR. Dose intensification strategy influences infliximab pharmacokinetics but not clinical response after the same number of doses. J Gastroenterol Hepatol. 2023;38:724‐732.

Choy MC, Li Wai Suen CFD, Con D, et al. Intensified versus standard dose infliximab induction therapy for steroid‐refractory acute severe ulcerative colitis (PREDICT‐UC): an open‐label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol. 2024;9:981‐996.

Church PC, Ho S, Sharma A, et al. Intensified infliximab induction is associated with improved response and decreased colectomy in steroid‐refractory paediatric ulcerative colitis. J Crohn's Col. 2019;13:982‐989.

Van Assche G, D'haens G, Noman M, et al. Randomized, double‐blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology. 2003;125:1025‐1031.

Hindryckx P, Jairath V, D'Haens G. Acute severe ulcerative colitis: from pathophysiology to clinical management. Nat Rev Gastroenterol Hepatol. 2016;13:654‐664.

Ogata H. A randomised dose finding study of oral tacrolimus (FK506) therapy in refractory ulcerative colitis. Gut. 2006;55:1255‐1262.

Ogata H, Kato J, Hirai F, et al. Double‐blind, placebo‐controlled trial of oral tacrolimus (FK506) in the management of hospitalized patients with steroid‐refractory ulcerative colitis. Inflamm Bowel Dis. 2012;18:803‐808.

Komaki Y, Komaki F, Ido A, Sakuraba A. Efficacy and safety of tacrolimus therapy for active ulcerative colitis; a systematic review and meta‐analysis. J Crohn's Col. 2016;10:484‐494.

Bousvaros A, Kirschner BS, Werlin SL, et al. Oral tacrolimus treatment of severe colitis in children. J Pediatr. 2000;137:794‐799.

Navas‐López VM, Blasco Alonso J, Serrano Nieto MJ, Girón Fernández‐Crehuet F, Argos Rodriguez MD, Sierra Salinas C. Oral tacrolimus for pediatric steroid‐resistant ulcerative colitis. J Crohn's Col. 2014;8:64‐69.

Ziring DA, Wu SS, Mow WS, Martín MG, Mehra M, Ament ME. Oral tacrolimus for steroid‐dependent and steroid‐resistant ulcerative colitis in children. J Pediatr Gastroenterol Nutr. 2007;45:306‐311.

Watson S, Pensabene L, Mitchell P, Bousvaros A. Outcomes and adverse events in children and young adults undergoing tacrolimus therapy for steroid‐refractory colitis. Inflamm Bowel Dis. 2011;17:22‐29.

Romano C, Comito D, Famiani A, Fries W. Oral tacrolimus (FK 506) in refractory paediatric ulcerative colitis. Aliment Pharmacol Ther. 2010;31:676‐677

author reply: 677‐678.

Hamel B, Wu M, Hamel EO, Bass DM, Park KT. Outcome of tacrolimus and vedolizumab after corticosteroid and anti‐TNF failure in paediatric severe colitis. BMJ Open Gastroenterol. 2018;5:e000195.

Yanagi T, Ushijima K, Koga H, et al. Tacrolimus for ulcerative colitis in children: a multicenter survey in Japan. Intest Res. 2019;17:476‐485.

Bolia R, Goel A, Semwal P, Srivastava A. Oral tacrolimus in steroid refractory and dependent pediatric ulcerative colitis: a systematic review and meta‐analysis. J Pediatr Gastroenterol Nutr. 2023;77:228‐234.

Laharie D, Bourreille A, Branche J, et al. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open‐label randomised controlled trial. Lancet. 2012;380:1909‐1915.

Williams JG, Alam MF, Alrubaiy L, et al. Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: pragmatic randomised Trial and economic evaluation (CONSTRUCT). Health Technol Assess (Rockv). 2016;20:1‐320.

Narula N, Marshall JK, Colombel JF, et al. Systematic review and meta‐analysis: infliximab or cyclosporine as rescue therapy in patients with severe ulcerative colitis refractory to steroids. Am J Gastroenterol. 2016;111:477‐491.

Zimmerman LA, Spaan J, Weinbren N, et al. Efficacy and safety of tacrolimus or infliximab therapy in children and young adults with acute severe colitis. J Pediatr Gastroenterol Nutr. 2023;77:222‐227.

Narula N, Fine M, Colombel JF, Marshall JK, Reinisch W. Systematic review: sequential rescue therapy in severe ulcerative colitis. Inflamm Bowel Dis. 2015;21:1683‐1694.

Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid‐refractory acute severe ulcerative colitis: a review. J Crohn's Col. 2023;17:972‐994.

Maser EA, Deconda D, Lichtiger S, Ullman T, Present DH, Kornbluth A. Cyclosporine and infliximab as rescue therapy for each other in patients with steroid‐refractory ulcerative colitis. Clin Gastroenterol Hepatol. 2008;6:1112‐1116.

Veyrard P, Pellet G, Laharie D, Nachury M, Juillerat P, Roblin X. Efficacy of induction therapy with calcineurin inhibitors in combination with ustekinumab for acute severe ulcerative colitis. Clin Gastroenterol Hepatol. 2023;21:1354‐1355 e2.

Singh A, Goyal MK, Midha V, et al. Tofacitinib in acute severe ulcerative colitis (TACOS): a randomized controlled trial. Am J Gastroenterol. 2024;119:1365‐1372.

Steenholdt C, Dige Ovesen P, Brynskov J, Seidelin JB. Tofacitinib for acute severe ulcerative colitis: a systematic review. J Crohn's Col. 2023;17:1354‐1363.

Constant BD, Baldassano R, Kirsch J, Mitchel EB, Stein R, Albenberg L. Tofacitinib salvage therapy for children hospitalized for corticosteroid‐ and biologic‐refractory ulcerative colitis. J Pediatr Gastroenterol Nutr. 2022;75:724‐730.

Costaguta GA, Girard C, Groleau V, Grzywacz K, Dirks MH, Deslandres C. The role of tofacitinib in the treatment of acute severe colitis in children. J Can Assoc Gastroenterol. 2024;7:196‐203.

Damianos JA, Osikoya O, Brennan G. Upadacitinib for acute severe ulcerative colitis: a systematic review. Inflamm Bowel Dis. 2024;31:1145‐1149.

Yerushalmy‐Feler A, Spencer EA, Dolinger MT, et al. Upadacitinib for induction of remission in pediatric ulcerative colitis: an international multi‑center study. J Crohns Col. 2025;19:jjae182.

Runde J, Ryan K, Hirst J, et al. Upadacitinib is associated with clinical response and steroid‐free remission for children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2025;80:133‐140.

Long MD, Farraye FA, Okafor PN, Martin C, Sandler RS, Kappelman MD. Increased risk of Pneumocystis jiroveci pneumonia among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:1018‐1024.

Cotter TG, Gathaiya N, Catania J, et al. Low risk of pneumonia from Pneumocystis jirovecii infection in patients with inflammatory bowel disease receiving immune suppression. Clin Gastroenterol Hepatol. 2017;15:850‐856.

Yoon J, Hong SW, Han KD, et al. Risk factors of Pneumocystis jirovecii pneumonia in patients with inflammatory bowel disease: a nationwide population‐based study. Gut Liver. 2024;18:489‐497.

Sierra CM, Daiya KC. Prophylaxis for Pneumocystis jirovecii pneumonia in patients with inflammatory bowel disease: a systematic review. Pharmacother J Hum Pharmacol Drug Ther. 2022;42:858‐867.

Kucharzik T, Ellul P, Greuter T, et al. ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease. J Crohn's Col. 2021;15:879‐913.

Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158:1450‐1461.

Bernardo S, Fernandes SR, Gonçalves AR, et al. Predicting the course of disease in hospitalized patients with acute severe ulcerative colitis. Inflamm Bowel Dis. 2019;25:541‐546.

Ho GT, Mowat C, Goddard CJ, et al. Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second‐line medical therapy or surgery. Aliment Pharmacol Ther. 2004;19:1079‐1087.

Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohn's Col. 2015;9:376‐381.

Grant RK, Jones GR, Plevris N, et al. The ACE (Albumin, CRP and Endoscopy) index in acute colitis: a simple clinical index on admission that predicts outcome in patients with acute ulcerative colitis. Inflamm Bowel Dis. 2021;27:451‐457.

Choy MC, Seah D, Gorelik A, et al. Predicting response after infliximab salvage in acute severe ulcerative colitis. J Gastroenterol Hepatol. 2018;33:1347‐1352.

Croft A, Lord A, Radford‐Smith G. Markers of systemic inflammation in acute attacks of ulcerative colitis: what level of C‐reactive protein constitutes severe colitis? J Crohn's Col. 2022;16:1089‐1096.

Yu S, Li H, Li Y, et al. Development and validation of novel models for the prediction of intravenous corticosteroid resistance in acute severe ulcerative colitis using logistic regression and machine learning. Gastroenterol Rep (Oxf). 2022;10:goac053.

Turner D, Walsh CM, Benchimol EI, et al. Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second‐line therapy. Gut. 2008;57:331‐338.

Atia O, Gupta A, Travis S, Turner D, Koslowsky B. The pediatric ulcerative colitis activity index (PUCAI) predicts steroid‐failure in adults with acute severe colitis. Scand J Gastroenterol. 2021;56:1049‐1055.

Turner D, Leach ST, Mack D, et al. Faecal calprotectin, lactoferrin, M2‐pyruvate kinase and S100A12 in severe ulcerative colitis: a prospective multicentre comparison of predicting outcomes and monitoring response. Gut. 2010;59:1207‐1212.

Jain S, Kedia S, Bopanna S, et al. Faecal calprotectin and UCEIS predict short‐term outcomes in acute severe colitis: prospective cohort study. J Crohn's Col. 2017;11:1309‐1316.

Sasidharan S, Sasson AN, Shannon KM, Ananthakrishnan AN. Fecal calprotectin is a predictor of need for rescue therapy in hospitalized severe colitis. Inflamm Bowel Dis. 2022;28:1833‐1837.

Ho GT, Lee HM, Brydon G, et al. Fecal calprotectin predicts the clinical course of acute severe ulcerative colitis. Am J Gastroenterol. 2009;104:673‐678.

Michail S, Durbin M, Turner D, et al. Alterations in the gut microbiome of children with severe ulcerative colitis. Inflamm Bowel Dis. 2012;18:1799‐1808.

Livshits A, Fisher D, Hadas I, et al. Abdominal X‐ray in pediatric acute severe colitis and radiographic predictors of response to intravenous steroids. J Pediatr Gastroenterol Nutr. 2016;62:259‐263.

Scarallo L, Maniscalco V, Paci M, et al. Bowel ultrasound scan predicts corticosteroid failure in children with acute severe colitis. J Pediatr Gastroenterol Nutr. 2020;71:46‐51.

Ilvemark JFKF, Wilkens R, Thielsen P, et al. Early intestinal ultrasound predicts intravenous corticosteroid response in hospitalised patients with severe ulcerative colitis. J Crohn's Col. 2022;16:1725‐1734.

Lee KE, Faye AS, Vermeire S, et al. Perioperative management of ulcerative colitis: a systematic review. Dis Colon Rectum. 2022;65:S5‐S19.

Fuller MK. Pediatric inflammatory bowel disease. Surg Clin North Am. 2019;99:1177‐1183.

Sako M, Kimura H, Arai K, et al. Restorative proctocolectomy for pediatric patients with ulcerative colitis. Surg Today. 2006;36:162‐165.

Berger M, Gribetz D, Korelitz BI. Growth retardation in children with ulcerative colitis: the effect of medical and surgical therapy. Pediatrics. 1975;55:459‐467.

Macleod A, Parks MA, Cook CN, Petras RE, Galandiuk S. Long‐term behavior and functional outcomes of ileal‐pouch anal anastomosis in inflammatory bowel disease with changing phenotype. Surgery. 2024;175:765‐775.

Hermand H, Lefèvre JH, Shields C, et al. Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease. Int J Colorectal Dis. 2021;36:709‐715.

Kayal M, Kohler D, Plietz M, et al. Early pouchitis is associated with Crohn's disease‐like pouch inflammation in patients with ulcerative colitis. Inflamm Bowel Dis. 2022;28:1821‐1825.

Akiyama S, Ollech JE, Traboulsi C, et al. Histopathology of colectomy specimens predicts endoscopic pouch phenotype in patients with ulcerative colitis. Dig Dis Sci. 2022;67:4020‐4031.

Raine T, Bonovas S, Burisch J, et al. ECCO guidelines on therapeutics in ulcerative colitis: medical treatment. J Crohn's Col. 2022;16:2‐17.

Spinelli A, Bonovas S, Burisch J, et al. ECCO guidelines on therapeutics in ulcerative colitis: surgical treatment. J Crohn's Col. 2022;16:179‐189.

Sahami S, Bartels SAL, D'Hoore A, et al. A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch‐anal anastomosis for inflammatory bowel disease. J Crohn's Col. 2016;10:773‐778.

Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2013;257:679‐685.

Roberts SE, Williams JG, Yeates D, Goldacre MJ. Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies. BMJ. 2007;335:1033.

Randall J, Singh B, Warren BF, Travis SPL, Mortensen NJ, George BD. Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications. Br J Surg. 2010;97:404‐409.

Singh S, Al‐Darmaki A, Frolkis AD, et al. Postoperative mortality among patients with inflammatory bowel diseases: a systematic review and meta‐analysis of population‐based studies. Gastroenterology. 2015;149:928‐937.

Ferrante M, DʼHoore A, Vermeire S, et al. Corticosteroids but not infliximab increase short‐term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis. 2009;15:1062‐1070.

Nguyen GC, Elnahas A, Jackson TD. The impact of preoperative steroid use on short‐term outcomes following surgery for inflammatory bowel disease. J Crohn's Col. 2014;8:1661‐1667.

Dragoni G, Innocenti T, Amiot A, et al. Rates of adverse events in patients with ulcerative colitis undergoing colectomy during treatment with tofacitinib vs biologics: a multicenter observational study. Am J Gastroenterol. 2024;119:1525‐1535.

Bajzat D, Keri AF, Imrei M, et al. Safety analysis of preoperative anti‐TNF‐alpha therapy in pediatric IBD after intestinal resection: a systematic review and meta‐analysis. Inflamm Bowel Dis. 2023;29:1971‐1980.

Cira K, Weber MC, Wilhelm D, Friess H, Reischl S, Neumann PA. The effect of anti‐tumor necrosis factor‐alpha therapy within 12 weeks prior to surgery on postoperative complications in inflammatory bowel disease: a systematic review and meta‐analysis. J Clin Med. 2022;11:6884.

Cohen BL, Fleshner P, Kane SV, et al. Prospective cohort study to investigate the safety of preoperative tumor necrosis factor inhibitor exposure in patients with inflammatory bowel disease undergoing intra‐abdominal surgery. Gastroenterology. 2022;163:204‐221.

Lightner AL, Mathis KL, Tse CS, et al. Postoperative outcomes in vedolizumab‐treated patients undergoing major abdominal operations for inflammatory bowel disease: retrospective multicenter cohort study. Inflamm Bowel Dis. 2018;24:871‐876.

Lightner AL, Raffals LE, Mathis KL, et al. Postoperative outcomes in vedolizumab‐treated patients undergoing abdominal operations for inflammatory bowel disease. J Crohn's Col. 2017;11:185‐190.

Lightner AL, Tse CS, Potter Jr. DD, Moir C. Postoperative outcomes in vedolizumab‐treated pediatric patients undergoing abdominal operations for inflammatory bowel disease. J Pediatr Surg. 2018;53:1706‐1709.

Park KT, Sceats L, Dehghan M, et al. Risk of post‐operative surgical site infections after vedolizumab vs anti‐tumour necrosis factor therapy: a propensity score matching analysis in inflammatory bowel disease. Aliment Pharmacol Ther. 2018;48:340‐346.

Kim JY, Zaghiyan K, Lightner A, Fleshner P. Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case‐control study. BMC Surg. 2020;20:46.

Moosvi Z, Duong JT, Bechtold ML, Nguyen DL. Systematic review and meta‐analysis: preoperative vedolizumab and postoperative complications in patients with IBD. South Med J. 2021;114:98‐105.

Hill SS, Ottaviano KE, Palange DC, et al. Impact of preoperative factors in patients with IBD on postoperative length of stay: a national surgical quality improvement program‐inflammatory bowel disease collaborative analysis. Dis Colon Rect. 2024;67:97‐106.

Resegotti A, Ribaldone DG. Is a protective stoma mandatory in anti‐tumor necrosis factor‐treated Crohn's disease patients undergoing surgery? Gastroenterology. 2023;164:307.

Maxwell EC, Dawany N, Baldassano RN, et al. Diverting ileostomy for the treatment of severe, refractory, pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2017;65:299‐305.

Russell TA, Dawes AJ, Graham DS, Angarita SAK, Ha C, Sack J. Rescue diverting loop ileostomy: an alternative to emergent colectomy in the setting of severe acute refractory IBD‐colitis. Dis Colon Rect. 2018;61:214‐220.

Yamamoto T, Shimoyama T, Umegae S, Kotze PG. Impact of preoperative nutritional status on the incidence rate of surgical complications in patients with inflammatory bowel disease with vs without preoperative biologic therapy: a case‐control study. Clin Transl Gastroenterol. 2019;10:e00050.

Barberan‐Garcia A, Ubré M, Roca J, et al. Personalised prehabilitation in high‐risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg. 2018;267:50‐56.

Howard R, Yin YS, McCandless L, Wang S, Englesbe M, Machado‐Aranda D. Taking control of your surgery: impact of a prehabilitation program on major abdominal surgery. J Am Coll Surg. 2019;228:72‐80.

Lee T, Clavel T, Smirnov K, et al. Oral versus intravenous iron replacement therapy distinctly alters the gut microbiota and metabolome in patients with IBD. Gut. 2017;66:863‐871.

Lee TW, Kolber MR, Fedorak RN, van Zanten SV. Iron replacement therapy in inflammatory bowel disease patients with iron deficiency anemia: a systematic review and meta‐analysis. J Crohn's Col. 2012;6:267‐275.

Dignass AU, Gasche C, Bettenworth D, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohn's Col. 2015;9:211‐222.

Bevers N, Van de Vijver E, Aliu A, et al. Ferric carboxymaltose versus ferrous fumarate in anemic children with inflammatory bowel disease: the POPEYE randomized controlled clinical trial. J Pediatr. 2023;256:113‐119 e4.

Gordon M, Sinopoulou V, Iheozor‐Ejiofor Z, et al. Interventions for treating iron deficiency anaemia in inflammatory bowel disease. Cochr Database Syst Rev. 2021;1:CD013529.

Maas LA, Krishna M, Parian AM. Ironing it all out: acomprehensive review of iron deficiency anemia in inflammatory bowel disease patients. Dig Dis Sci. 2023;68:357‐369.

Klomberg RCW, Vlug LE, de Koning BAE, de Ridder L. Venous thromboembolic complications in pediatric gastrointestinal diseases: inflammatory bowel disease and intestinal failure. Front Pediatr. 2022;10:885876.

Alhassan N, Trepanier M, Sabapathy C, et al. Risk factors for post‐discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis. Tech Coloproctol. 2018;22:955‐964.

Tsai L, Ma C, Dulai PS, et al. Contemporary risk of surgery in patients with ulcerative colitis and Crohn's disease: a meta‐analysis of population‐based cohorts. Clin Gastroenterol Hepatol. 2021;19:2031‐2045 e11.

Ihekweazu FD, Fofanova T, Palacios R, et al. Progression to colectomy in the era of biologics: a single center experience with pediatric ulcerative colitis. J Pediatr Surg. 2020;55:1815‐1823.

Gordon H, Biancone L, Fiorino G, et al. ECCO guidelines on inflammatory bowel disease and malignancies. J Crohn's Col. 2023;17:827‐854.

Barnes EL, Herfarth HH, Sandler RS, et al. Pouch‐related symptoms and quality of life in patients with ileal pouch‐anal anastomosis. Inflamm Bowel Dis. 2017;23:1218‐1224.

Egberg MD, Galanko JA, Kappelman MD. Patients who undergo colectomy for pediatric ulcerative colitis at low‐volume hospitals have more complications. Clin Gastroenterol Hepatol. 2019;17:2713‐2721.e4.

Burns EM, Bottle A, Aylin P, et al. Volume analysis of outcome following restorative proctocolectomy. J Bri Surg. 2011;98:408‐417.

Orlanski‐Meyer E, Topf‐Olivestone C, Ledder O, et al. Outcomes following pouch formation in paediatric ulcerative colitis: a study from the porto group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2020;71:346‐353.

Buchs NC, Bloemendaal ALA, Wood CPJ, et al. Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre. Colorectal Dis. 2017;19:O153‐O161.

Denning NL, Kallis MP, Kvasnovsky CL, Lipskar AM. Outcomes of initial subtotal colectomy for pediatric inflammatory bowel disease. J Surg Res. 2020;255:319‐324.

Gorgun E, Cengiz TB, Aytac E, et al. Does laparoscopic ileal pouch‐anal anastomosis reduce infertility compared with open approach? Surgery. 2019;166:670‐677.

Diamond IR, Gerstle JT, Kim PCW, Langer JC. Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc. 2010;24:2796‐2802.

Muntean A, Stoica I, McMahon SV, Mortell A, Gillick J, Sweeney BT. Colectomies in children with inflammatory bowel disease: a national referral centre experience. Pediatr Surg Int. 2019;35:691‐698.

Narula N, Charleton D, Marshall JK. Meta‐analysis: peri‐operative anti‐TNFα treatment and post‐operative complications in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37:1057‐1064.

Patton D, Gupta N, Wojcicki JM, Garnett EA, Nobuhara K, Heyman MB. Postoperative outcome of colectomy for pediatric patients with ulcerative colitis. J Pediatr Gastroenterol Nutr. 2010;51:151‐154.

Nallapaneni P, Picoraro JA. Diagnosis and treatment of pouch disorders in children: a systematic review. Dis Colon Rectum. 2024;67:S115‐S124.

Luo WY, Singh S, Cuomo R, Eisenstein S. Modified two‐stage restorative proctocolectomy with ileal pouch‐anal anastomosis for ulcerative colitis: a systematic review and meta‐analysis of observational research. Int J Colorectal Dis. 2020;35:1817‐1830.

Chaouch MA, Hussain MI, Gouader A, et al. Stapled anastomosis versus hand‐sewn anastomosis with mucosectomy for ileal pouch‐anal anastomosis: a systematic review and meta‐analysis of postoperative outcomes, functional outcomes, and oncological safety. Cancer Control. 2024;31:10732748241236338.

Remzi FH, Aytac E, Ashburn J, et al. Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: lessons learned over 500 patients. Ann Surg. 2015;262:675‐682.

Lightner AL, Alsughayer A, Wang Z, McKenna NP, Seisa MO, Moir C. Short‐ and long‐term outcomes after ileal pouch anal anastomosis in pediatric patients: a systematic review. Inflamm Bowel Dis. 2019;25:1152‐1168.

Nasseri Y, Melmed G, Wang HL, Targan S, Fleshner P. Rigorous histopathological assessment of the colectomy specimen in patients with inflammatory bowel disease unclassified does not predict outcome after ileal pouch‐anal anastomosis. Am J Gastroenterol. 2010;105:155‐161.

Murrell ZA, Melmed GY, Ippoliti A, et al. A prospective evaluation of the long‐term outcome of ileal pouch‐anal anastomosis in patients with inflammatory bowel disease‐unclassified and indeterminate colitis. Dis Colon Rect. 2009;52:872‐878.

Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male fertility after colectomy and reconstructive surgery in inflammatory bowel disease: a national cohort study from Sweden. J Crohn's Col. 2023;17:1631‐1638.

Rajaratnam SG, Eglinton TW, Hider P, Fearnhead NS. Impact of ileal pouch‐anal anastomosis on female fertility: meta‐analysis and systematic review. Int J Colorectal Dis. 2011;26:1365‐1374.

Beyer‐Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y. A total laparoscopic approach reduces the infertility rate after ileal pouch‐anal anastomosis: a 2‐center study. Ann Surg. 2013;258:275‐282.

Pakarinen MP, Natunen J, Ashorn M, et al. Long‐term outcomes of restorative proctocolectomy in children with ulcerative colitis. Pediatrics. 2009;123:1377‐1382.

Shen B, Kochhar GS, Kariv R, et al. Diagnosis and classification of ileal pouch disorders: consensus guidelines from the international ileal pouch consortium. Lancet Gastroenterol Hepatol. 2021;6:826‐849.

Santiago P, Barnes EL, Raffals LE. Classification and management of disorders of the J pouch. Am J Gastroenterol. 2023;118:1931‐1939.

Patel PV, Kao E, Stekol E, Heyman MB, Vu L, Verstraete SG. Evaluating the relationship between nutrition and post‐colectomy pouchitis in pediatric patients with ulcerative colitis. Dig Dis Sci. 2023;68:2188‐2195.

Cowherd E, Egberg MD, Kappelman MD, et al. The cumulative incidence of pouchitis in pediatric patients with ulcerative colitis. Inflamm Bowel Dis. 2022;28:1332‐1337.

Runde J, Erondu A, Akiyama S, et al. Outcomes of ileoanal pouch anastomosis in pediatric ulcerative colitis are worse in the modern era: a time trend analysis outcomes following ileal pouch‐anal anastomosis in pediatric ulcerative colitis. Inflamm Bowel Dis. 2022;28:1386‐1394.

Dipasquale V, Mattioli G, Arrigo S, et al. Pouchitis in pediatric ulcerative colitis: a multicenter study on behalf of Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition. Dig Liver Dis. 2019;51:1551‐1556.

Jarchin L, Spencer EA, Khaitov S, et al. De novo Crohn's disease of the pouch in children undergoing ileal pouch‐anal anastomosis for ulcerative colitis. J Pediatr Gastroenterol Nutr. 2019;69:455‐460.

Koike Y, Uchida K, Inoue M, et al. Early first episode of pouchitis after ileal pouch‐anal anastomosis for pediatric ulcerative colitis is a risk factor for development of chronic pouchitis. J Pediatr Surg. 2019;54:1788‐1793.

Rinawi F, Assa A, Eliakim R, et al. Predictors of pouchitis after ileal pouch‐anal anastomosis in pediatric‐onset ulcerative colitis. Eur J Gastroenterol Hepatol. 2017;29:1079‐1085.

Bismar N, Patel AS, Schindel DT. Does age affect surgical outcomes after ileal pouch‐anal anastomosis in children? J Surg Res. 2019;237:61‐66.

Kmeid M, Arker SH, Petchers A, et al. Appendiceal inflammation in colectomy is independently correlated with early pouchitis following ileal pouch anal anastomosis in ulcerative colitis and indeterminate colitis. Ann Diagn Pathol. 2021;55:151838.

Dharmaraj R, Dasgupta M, Simpson P, Noe J. Predictors of pouchitis after ileal pouch‐anal anastomosis in children. J Pediatr Gastroenterol Nutr. 2016;63:e58‐e62.

Koike Y, Uchida K, Inoue M, et al. Predictors for pouchitis after ileal pouch‐anal anastomosis for pediatric‐onset ulcerative colitis. J Surg Res. 2019;238:72‐78.

Akiyama S, Ollech JE, Rai V, et al. Endoscopic phenotype of the J pouch in patients with inflammatory bowel disease: a new classification for pouch outcomes. Clin Gastroenterol Hepatol. 2022;20:293‐302.e9.

Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch‐anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc. 1994;69:409‐415.

Sedano R, Ma C, Pai RK, et al. An expert consensus to standardise clinical, endoscopic and histologic items and inclusion and outcome criteria for evaluation of pouchitis disease activity in clinical trials. Aliment Pharmacol Ther. 2021;53:1108‐1117.

Sedano R, Nguyen TM, Almradi A, et al. Disease activity indices for pouchitis: a systematic review. Inflamm Bowel Dis. 2022;28:622‐638.

Pemberton JH. The problem with pouchitis. Gastroenterology. 1993;104:1209‐1211.

Gupta A, Kizza JFN, Ananthakrishnan AN. Histologic activity in an endoscopically normal‐appearing pouch predicts future risk of pouchitis in patients with ulcerative colitis. Am J Gastroenterol. 2023;118:174‐177.

Martinelli M, Romeo E, Caldaro T, et al. De novo Crohn's disease in children with ulcerative colitis undergoing ileal pouch‐anal anastomosis: a multicenter, retrospective study from the pediatric IBD porto group of the ESPGHAN. Inflamm Bowel Dis. 2024;30:1475‐1481.

Reijntjes M, de Jong D, Wessels E, et al. Crohn's disease of the ileoanal pouch: a high rate of potential overdiagnoses. Inflamm Bowel Dis. 2024;30:1635‐1641.

Slatter C, Girgis S, Huynh H, El‐Matary W. Pre‐pouch ileitis after colectomy in paediatric ulcerative colitis. Acta Paediatr (Stockholm). 2008;97:381‐383.

Poo S, Sriranganathan D, Segal JP. Network meta‐analysis: efficacy of treatment for acute, chronic, and prevention of pouchitis in ulcerative colitis. Eur J Gastroenterol Hepatol. 2022;34:518‐528.

Nguyen N, Zhang B, Holubar SD, et al. Treatment and prevention of pouchitis after ileal pouch‐anal anastomosis for chronic ulcerative colitis. Cochrane Database Syst Rev. 2019;11:Cd001176.

Emile SH, Horesh N, Freund MR, et al. A systematic review and meta‐analysis of randomized clinical trials on the prevention and treatment of pouchitis after ileoanal pouch anastomosis. J Gastrointest Surg. 2023;27:2650‐2660.

Segal JP, Ding NS, Worley G, et al. Systematic review with meta‐analysis: the management of chronic refractory pouchitis with an evidence‐based treatment algorithm. Aliment Pharmacol Ther. 2017;45:581‐592.

Huguet M, Pereira B, Goutte M, et al. Systematic review with meta‐analysis: anti‐TNF therapy in refractory pouchitis and Crohn's disease‐like complications of the pouch after ileal pouch‐anal anastomosis following colectomy for ulcerative colitis. Inflamm Bowel Dis. 2018;24:261‐268.

Gionchetti P, Rizzello F, Poggioli G, et al. Oral budesonide in the treatment of chronic refractory pouchitis. Aliment Pharmacol Ther. 2007;25:1231‐1236.

Travis S, Silverberg MS, Danese S, et al. Vedolizumab for the treatment of chronic pouchitis. N Engl J Med. 2023;388:1191‐1200.

Ribaldone DG, Pellicano R, Saracco GM, Morino M, Astegiano M. Vedolizumab for treatment of chronic refractory pouchitis: a systematic review with pool analysis. Rev Esp Enferm Dig. 2020;112:59‐63.

Chandan S, Mohan BP, Kumar A, et al. Safety and efficacy of biological therapy in chronic antibiotic refractory pouchitis: a systematic review with meta‐analysis. J Clin Gastroenterol. 2021;55:481‐491.

Godoy‐Brewer G, Salem G, Limketkai B, et al. Use of biologics for the treatment of inflammatory conditions of the pouch: a systematic review. J Clin Gastroenterol. 2024;58:183‐194.

Bedrikovetski S, Dudi‐Venkata N, Kroon HM, et al. Systematic review of rectal stump management during and after emergency total colectomy for acute severe ulcerative colitis. ANZ J Surg. 2019;89:1556‐1560.

Hembree AE, Scherl E. Diagnosis and management of cuffitis: a systematic review. Dis Colon Rect. 2022;65:S85‐S91.

Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch‐anal anastomoses. Inflamm Bowel Dis. 2013;19:404‐410.

Barnes EL, Agrawal M, Syal G, et al. AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders. Gastroenterology. 2024;166:59‐85.

Falloon K, Cohen BL, Ottichilo R, et al. Biomarkers for the evaluation of pouch inflammation: a systematic review. Crohn's Col 360. 2022;4:otac043.

Turner D, Mack D, Leleiko N, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response. Gastroenterology. 2010;138:2282‐2291.

Russell RK, Protheroe A, Roughton M, et al. Contemporary outcomes for ulcerative colitis inpatients admitted to pediatric hospitals in the United Kingdom. Inflamm Bowel Dis. 2013;19:1434‐1440.

Turner D, Griffiths AM, Veerman G, et al. Endoscopic and clinical variables that predict sustained remission in children with ulcerative colitis treated with infliximab. Clin Gastroenterol Hepatol. 2013;11:1460‐1465.

Hyams JS, Davis S, Mack DR, et al. Factors associated with early outcomes following standardised therapy in children with ulcerative colitis (PROTECT): a multicentre inception cohort study. Lancet Gastroenterol Hepatol. 2017;2:855‐868.

Ghahramani S, Tamartash Z, Sayari M, et al. Risk factors affecting 90‐day readmission of patients with inflammatory bowel disease. Middle East J Dig Dis. 2022;14:34‐43.

Nguyen NH, Koola J, Dulai PS, Prokop LJ, Sandborn WJ, Singh S. Rate of risk factors for and interventions to reduce hospital readmission in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2020;18:1939‐1948.e7.

Faye AS, Wen T, Ananthakrishnan AN, et al. Acute venous thromboembolism risk highest within 60 days after discharge from the hospital in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2020;18:1133‐1141.e3.

Hyams JS, Lerer T, Mack D, et al. Outcome following thiopurine use in children with ulcerative colitis: a prospective multicenter registry study. Am J Gastroenterol. 2011;106:981‐987.

Ardizzone S. Randomised controlled trial of azathioprine and 5‐aminosalicylic acid for treatment of steroid dependent ulcerative colitis. Gut. 2006;55:47‐53.

Sternthal MB, Murphy SJ, George J, Kornbluth A, Lichtiger S, Present DH. Adverse events associated with the use of cyclosporine in patients with inflammatory bowel disease. Am J Gastroenterol. 2008;103:937‐943.

Pellet G, Stefanescu C, Carbonnel F, et al. Efficacy and safety of induction therapy with calcineurin inhibitors in combination with vedolizumab in patients with refractory ulcerative colitis. Clin Gastroenterol Hepatol. 2019;17:494‐501.

Rahier JF, Magro F, Abreu C, et al. Second European evidence‐based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohn's Col. 2014;8:443‐468.

Long MD, Farraye FA, Okafor PN, Martin C, Sandler RS, Kappelman MD. Increased risk of Pneumocystis jiroveci pneumonia among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:1018‐1024.

Desales AL, Mendez‐Navarro J, Méndez‐Tovar LJ, et al. Pneumocystosis in a patient with Crohn's disease treated with combination therapy with adalimumab. J Crohn's Col. 2012;6:483‐487.

Cotter TG, Gathaiya N, Catania J, et al. Low risk of pneumonia from Pneumocystis jirovecii infection in patients with inflammatory bowel disease receiving immune suppression. Clin Gastroenterol Hepatol. 2017;15:850‐856.

Alrubaiy L, Hutchings HA, Louca A, et al. Quality of life in patients with acute severe ulcerative colitis: long‐term follow‐up results from the CONSTRUCT trial. J Pers Med. 2022;12:2039.

Management of paediatric ulcerative colitis, part 1: Ambulatory care-An updated evidence-based consensus guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation