Eytan Wine, Marina Aloi, Stephanie Van Biervliet, Jiri Bronsky, Javier Martín di Carpi, Marco Gasparetto, Laura Gianolio, Hannah Gordon, Iva Hojsak, Alexandra S. Hudson, Séamus Hussey, Johan van Limbergen, Erasmo Miele, Lorenzo Norsa, Ola Olén, Gianluca Pellino, Patrick van Rheenen, Lissy de Ridder, Richard K. Russell, Dror S. Shouval, Eunice Trindade, Dan Turner, David C. Wilson, Anat Yerushalmy Feler, Amit Assa

J Pediatr Gastroenterol Nutr. 2025; 1-51. doi:10.1002/jpn3.70097

Objectives

Despite advances in the management of ambulatory paediatric ulcerative colitis (UC), challenges remain as many patients are refractory to therapy and some require colectomy. The aim of these guidelines is to provide an update on optimal care for UC through detailed recommendations and practice points.

Methods

These guidelines are an update to those published in 2018 and are a joint effort of the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organisation. An extensive literature search with subsequent evidence appraisal using the Oxford methodology was performed, followed by three online voting sessions and a consensus face-to-face meeting. Thirty-nine recommendations and 77 practice points were endorsed by the 25 experts with at least an 84% consensus rate.

Results

Robust evidence-based recommendations and detailed practice points are provided. In addition to reemphasising and updating the role of more ‘traditional’ UC therapies, these guidelines outline optimising the use of antitumour necrosis factor therapies and integrating newer biologics and small molecules, as well as supportive therapy, to improve outcomes and provide an updated management algorithm. Measurement and monitoring tools and decision aids are provided, and additional aspects, including nutritional support, extraintestinal manifestations, pouchitis, inflammatory bowel disease-unclassified and patient support, are discussed. Some aspects, including surgery and thromboprophylaxis, are covered in the acute severe UC guidelines.

GMA has a good safety profile, especially in difficult-to-treat and paediatric settings^. GMA also requires central venous access but may still be considered in children with UC who do not respond or lose response to conventional treatments, but more studies are needed before formal recommendations can be made.

Conclusions

These guidelines serve as an aid in managing children with UC through a combination of evidence-based recommendations and more practical practice points in the ambulatory setting.

Vaios Svolos, Hannah Gordon ¹, Miranda C E Lomer ², Marina Aloi ^3 4, Aaron Bancil ⁵, Alice S Day ⁶, Andrew S Day ⁷, Jessica A Fitzpatrick ⁸, Konstantinos Gerasimidis ⁹, Konstantinos Gkikas ⁹, Lihi Godny ¹⁰, Charlotte R H Hedin ^11 12, Konstantinos Katsanos ¹³, Neeraj Narula ¹⁴, Richard K Russell ¹⁵, Chen Sarbagili-Shabat ^16 17, Jonathan P Segal ^18 19, Rotem Sigall-Boneh ^20 21, Harry Sokol ²², Catherine L Wall ²³, Kevin Whelan ², Eytan Wine ²⁴, Henit Yanai ^25 26, Richard Hansen, Emma P Halmos ²⁷

J Crohns Colitis. 2025 Jul 12:jjaf122. doi: 10.1093/ecco-jcc/jjaf122. Online ahead of print.

curcumin & qing dai statements: 16.1, 16.2, 16.3

Documento de posicionamiento de geteccu sobre fragilidad, edad avanzada y enfermedad inflamatoria intestinal

Míriam Mañosa ^a, Margalida Calafat ^a, Esther Francia ^b, Francesc Riba ^c, Francisco Mesonero ^d, Cristina Suárez ^e, Santiago García-López ^f, Francisco Losfablos ^g, Xavier Calvet ^hi, Eugeni Domènech ^ai, Ana Gutiérrez Casbas ^j, Ingrid Ordás ^k, Luis Menchén ^l, Francisco Rodríguez-Moranta ^m, Yamile Zabana ⁿ

Gastroenterología y Hepatología, 2025, 502529, ISSN 0210-5705, https://doi.org/10.1016/j.gastrohep.2025.502529.

Resumen

La fragilidad es un estado de vulnerabilidad caracterizado por una disminución de la reserva fisiológica y la capacidad de respuesta ante el estrés, lo que aumenta el riesgo de complicaciones, efectos adversos a los tratamientos y al deterioro funcional. La valoración de la fragilidad permite determinar la edad biológica de los pacientes, más allá de su edad cronológica, proporcionando una visión más precisa de su estado de salud y necesidades asistenciales. La proporción de adultos de edad avanzada con EII se halla en aumento de forma paralela al envejecimiento de la población general y se estima que, en la próxima década, más de un tercio de los pacientes con EII superarán los 60 años. Esta población puede sufrir las complicaciones derivadas de la propia EII desarrolladas previamente a la vez que es particularmente susceptible a desarrollar efectos secundarios del tratamiento, lo que hace imprescindible su evaluación integral con el fin de identificar aquellos más vulnerables. A la fragilidad se unen otros síndromes geriátricos como la comorbilidad y la polifarmacia que pueden interferir de forma notable con el manejo y el curso de la EII, condicionando la estrategia terapéutica y el pronóstico.

Objetivo

En este contexto, la evaluación geriátrica integral debe ser sistemática en los pacientes de edad avanzada con EII, con el objetivo de detectar déficits funcionales e implementar intervenciones específicas de apoyo nutricional, rehabilitación funcional y atención psicológica para optimizar su evolución. Este documento de posicionamiento pretende establecer recomendaciones al respecto basadas en la evidencia disponible.

Conclusiones

La incorporación sistemática de la valoración geriátrica integral en el manejo de personas mayores con EII representa una estrategia esencial para mejorar los resultados clínicos, adaptar los tratamientos a la capacidad funcional del paciente y favorecer un enfoque verdaderamente centrado en la persona.

Recomendamos valorar el uso de GMA en los pacientes frágiles o de edad avanzada con EII corticodependientes por su seguridad.

En los pacientes con EII de edad avanzada o en situación de fragilidad, donde el riesgo de efectos adversos por inmunosupresores y corticoides es mayor, la GMA puede representar una opción terapéutica segura. Esta estrategia permite controlar la inflamación sin incrementar significativamente el riesgo de infecciones o neoplasias. Disponemos de datos que han demostrado que la GMA puede inducir remisión clínica en un porcentaje considerable de pacientes mayores con CU moderada o grave, con un perfil de seguridad favorable y sin eventos adversos graves, incluso en presencia de múltiples comorbilidades

Toshiyuki Yamamoto, Kenshi Yamasaki, Keiichi Yamanaka, Mayumi Komine, Tamihiro Kawakami, Osamu Yamamoto, Takuro Kanekura, Tetsuya Higuchi, Toshiya Takahashi, Yoshiaki Matsushima, Nobuyuki Kikuchi, Japanese Dermatological Association Pyoderma Gangrenosum Treatment Guidelines Drafting Committee Journal of Dermatology 50 (9) 2023, e253-e275 doi.org=10.1111/1346-8138.16845

Pyoderma gangrenosum (PG) is a rare, neutrophilic skin disease. For the purpose of accurate diagnosis and proper treatment of PG, the Japanese clinical practice guidance for PG developed by the Japanese Dermatological Association was published in 2022. In this guidance, clinical aspects, pathogenesis, current therapies, and clinical questions on PG are described from the viewpoints of current knowledge and evidence-based medicine. Here, the English version of the Japanese clinical practice guidelines for PG is presented and is intended to be widely referred to in the clinical examination and treatment of PG.

Allergic and Immunologic Diseases

A Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic Diseases 2022, Pages 1527-1583

Apheresis is a term for a group of extracorporeal treatments in which blood is separated into its components, with some components being discarded and replaced or subsequently modified. The replacement fluids/cells or modified components, along with the remainder of the blood, are then returned to the patient. These procedures can alter the immune system, both humoral and cellular, and have been used to treat a variety of common and uncommon immunologic diseases beginning in the late 1950s. The basic background information important for understanding those apheresis procedures used to treat immunologic disorders as well as the important patient considerations are discussed. A synopsis of immunologic diseases treated with apheresis, based upon the American Society for Apheresis Guidelines for the use of apheresis in clinical practice, is provided including treatment schedules and “dosing,” patient evaluation and laboratory monitoring, and the proposed mechanism of action. Unique considerations for each treatment, such as their effects on patient management and concurrent therapies, are also discussed. Apheresis is a group of related therapies that can effectively treat several immunologic diseases with a growing but still a limited base of published evidence.

The use of therapeutic apheresis in allergic and immunological diseases – ScienceDirect

Nina Worel ¹, Behrouz Mansouri Taleghani ², Erwin Strasser ³ Transfus Med Hemother 2019 Dec;46(6):394-406. doi: 10.1159/000503937. Epub 2019 Nov 6.

The section «Preparative and Therapeutic Hemapheresis» of the German Society for Transfusion Medicine and Immunohematology (DGTI) has reviewed the actual literature and updated techniques and indications for evidence-based use of therapeutic apheresis in human disease. The recommendations are mostly in line with the «Guidelines on the Use of Therapeutic Apheresis in Clinical Practice» published by the Writing Committee of the American Society for Apheresis (ASFA) and have been conducted by experts from the DACH (Germany, Austria, Switzerland) region.

https://pubmed.ncbi.nlm.nih.gov/31933569/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944925/

Kazuaki Inoue, Tomoki Furuya, Yoko Yokoyama

The apheresis guidelines for digestive diseases are divided into the following four fields: acute liver failure (ALF); ascites; acute pancreatitis (AP); inflammatory bowel disease (IBD).

IBD: Ulcerative colitis (UC) and Crohn’s disease (CD) are the major forms of I BD. Although their etiology is still not fully understood, activated leukocytes are significant factors in their exacerbations. In Japan, granulocyte and monocyte apheresis (GMA) and leukocytapheresis (LCAP) are approved for IBD treatment. They are recommended for remission induction in UC
patients with mild-to-moderate activity, whether steroid-resistant or -dependent. Although GMA is recommended for remission induction in colonic type CD refractory to conventional therapy, its efficacy is lower than in UC patients.

poster at ISFA 2019 pag 100-101

http://www.atalacia.com/isfa/data/abstract.pdf

Dan Turner ¹, Frank M Ruemmele ², Esther Orlanski-Meyer ¹, Anne M Griffiths ³, Javier Martin de Carpi  et al. J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):257-291. doi: 10.1097/MPG.0000000000002035.

Background: The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with ∼20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of pediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. Methods: These guidelines are a joint effort of the European Crohn’s and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before 2 face-to-face meetings. All 40 included recommendations and 86 practice points were endorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate. Results: These guidelines discuss how to optimize the use of mesalamine (including topical), systemic and locally active steroids, thiopurines and, for more severe disease, biologics. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision-making based on clinical assessment and the Paediatric UC Activity Index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, as well as other management considerations around pouchitis, extraintestinal manifestations, nutrition, growth, psychology, and transition. A brief section on disease classification using the PIBD-classes criteria and IBD-unclassified is also part of these guidelines. Conclusions: These guidelines provide a guide to clinicians managing children with UC and IBD-unclassified management to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

https://pubmed.ncbi.nlm.nih.gov/30044357/

https://www.zora.uzh.ch/id/eprint/165387/

Hideki Fujita ¹, Tadashi Terui ¹, Koremasa Hayama ¹, Masashi Akiyama ², Shigaku Ikeda ³, Tomotaka Mabuchi ⁴, Akira Ozawa ⁴, Takuro Kanekura ⁵, Michiko Kurosawa ⁶, Mayumi Komine ⁷, Kimiko Nakajima ⁸, Shigetoshi Sano ⁸, Osamu Nemoto ⁹, Masahiko Muto ¹⁰, Yasutomo Imai ¹¹, Kiyofumi Yamanishi ¹¹, Yumi Aoyama ¹², Keiji Iwatsuki ¹³, J Dermatol . 2018 Nov;45(11):1235-1270. 

 The aim of the guidelines was to provide current information to aid in the treatment of patients with GPP in Japan. Its contents include the diagnostic and severity classification criteria for GPP, its pathogenesis, and recommendations for the treatment of GPP.

https://pubmed.ncbi.nlm.nih.gov/30230572/

Katsuyoshi Matsuoka ¹, Taku Kobayashi ¹, Fumiaki Ueno ^2 3, Toshiyuki Matsui ¹, Fumihito Hirai ¹, Nagamu Inoue ¹, Jun Kato ¹, Kenji Kobayashi ¹, Kiyonori Kobayashi ¹, Kazutaka Koganei ¹, Reiko Kunisaki ¹, Satoshi Motoya ¹, Masakazu Nagahori ¹, Hiroshi Nakase ¹, Fumio Omata ¹, Masayuki Saruta ¹, Toshiaki Watanabe ¹, Toshiaki Tanaka ¹, Takanori Kanai ¹, Yoshinori Noguchi ¹, Ken-Ichi Takahashi ¹, Kenji Watanabe ¹, Toshifumi Hibi ¹, Yasuo Suzuki ¹, Mamoru Watanabe ¹, Kentaro Sugano ¹, Tooru Shimosegawa ¹ , J Gastroenterol. 2018 Mar;53(3):305-353.

Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn’s disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.

https://pubmed.ncbi.nlm.nih.gov/29429045/

Evidence-based clinical practice guidelines for inflammatory bowel disease – PMC (nih.gov)