大多数UC起病隐匿，或轻度腹泻，便血，仅见大便潜血。约30%患儿症状明显，起病较急，多见婴幼儿，腹泻可达10～30次/d，呈血便或黏液血便、脓血便，侵犯直肠者有里急后重。痉挛性腹痛常于便前、便时发生，便后缓解。左下腹触痛明显，可有肌紧张或触及硬管状结肠。全身症状有发热、乏力、贫血;病情严重则有脱水、电解质紊乱、酸碱平衡失调等。体重不增、生长发育迟缓亦是小儿UC最早期临床表现。可有肠外表现如关节炎、关节痛、虹膜睫状体炎、肝大等。

　　欧洲克罗恩病和溃疡性结肠炎组织（ECCO）和欧洲儿科胃肠病学、肝病学和营养协会（ESPGHAN）在7月初联合发布了“儿童溃疡性结肠炎诊治指南”，共达成40条推荐和68条临床实践意见，包括初始评估，病情评价，内镜评估的价值，药物及外科治疗，治疗旪机选择，联合治疗的作用以及何时停药,并根据儿童溃疡性结肠炎活动指数（PUCAI）评分给出了治疗流程图，这部指南既提供了标准化框架去规范如何监测病情和治疗，也考虑到了个体患者的特殊需求【1】。
　　儿童期发作患者有其特殊之处，治疗上应引起重视，如个体化治疗。美国儿童医院的研究者探讨性别对于儿科炎症性肠病患者治疗和转归的影响，研究结果并不支持将性别因素作为炎症性肠病患儿风险分层的主要影响因素【2】。
　　北美儿科胃肠病、肝脏病和营养学会（NASPGHAN）也在同期发布了成人和儿童炎症性肠病患者卫生监管共识，其中指出初级保健医生应该在炎症性肠病患儿的治疗中发挥积极的作用，应建立初级保健医生和与科医生的良好协作，以助初级保健医生和专科医生之间更好的协作、造福患者【3】。

     背景与目的：小儿溃疡性结肠炎（UC）与成人溃疡性结肠炎有许多共同特征，但也有一些差异；因此，治疗方法必须个性化。我们的目的是基于文献的系统回顾及强大的共识过程， 制定UC患儿的管理指南。本文是欧洲克罗恩病和溃疡性结肠炎组织（ECCO）及欧洲儿科胃肠病学、肝病学和营养协会（ESPGHAN）共同努力的结果。

     方法：继公开召集ESPGHAN和ECCO成员后，27名儿科IBD的专家参与了反复多次的共识过程，包括2个面对面会议。解决了工作组基于系统性回顾文献预设的23个问题。

    结果：考虑初始疾病评估、如何监测疾病的活动、内镜评估的作用、药物和手术治疗、药物的选择和治疗时机、联合治疗的作用及停药时间等因素后，有40个正式建议和68个实践要点被采纳，共识率达89%以上。基于小儿溃疡性结肠炎活动指数(PUCAI)，一份管理流程图出台。

   结论：这些指南提供临床上有用的要点来指导儿童UC的管理。总的来说，在承认存在个体差异的同时，该指南提供了一个标准，便于有效的、及时的管理与监测病程 。

Management of Pediatric Ulcerative Colitis: Joint ECCO and ESPGHAN Evidence-based Consensus Guidelines

Background and Aims: Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn’s and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN).

Methods: A group of 27 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to ESPGHAN and ECCO members. A list of 23 predefined questions were addressed by working subgroups based on a SR of the literature.

Results: A total of 40 formal recommendations and 68 practice points were endorsed with a consensus rate of at least 89% regarding initial evaluation, how to monitor disease activity, the role of endoscopic evaluation, medical and surgical therapy, timing and choice of each　medication, the role of combined therapy, and when to stop medications. A management flowchart, based on the Pediatric Ulcerative Colitis Activity Index (PUCAI), is presented.

Conclusions: These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.

Ref：

1.D, Levine A, Escher JC, et al. Management of Pediatric Ulcerative Colitis: A Joint ECCO and ESPGHAN Evidence-Based Consensus Guidelines. J  Pediatr Gastroentero lNutr. 2012 Jul 4.

2.Stocco G, De Iudicibus S, et al. Personalized therapies in pediatric inflammatory and autoimmune diseases. Curr Pharm Des. 2012.

3.Rufo PA,Denson LA,Sylvester FA, et al. Health Supervision in the Management of Children and Adolescents With IBD: NASPGHAN Recommendations.  JPediatrGastroenterolNutr. 2012Jul;55(1):93-108.