Ulcerative colitis and Crohn's disease are the two most common forms of idiopathic inflammatory bowel disease (IBD). Ulcerative colitis differs from Crohn's disease in that the inflammation in ulcerative colitis is confined to the mucosal layer of the colon. In contrast, Crohn's disease is characterized by transmural inflammation in either a limited region or extensively in the bowel, and may involve any portion of the gastrointestinal tract from the mouth to the anus. The peak incidence of IBD occurs between the ages of 15 and 25 years, but ulcerative colitis may begin at any age.1 Approximately 20% of patients with ulcerative colitis present before the age of 20 years.2 While children and adults develop similar symptoms, children often present with more extensive disease.3 Clinicians caring for children and adolescents with ulcerative colitis must treat both the gastrointestinal and extraintestinal complications, optimize nutrition and linear growth, and address the psychosocial ramifications of the illness. Since the majority of the published studies investigating the natural history and treatment of ulcerative colitis are in adults, we refer primarily to these studies, with reference to pediatric studies where available.

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