Pediatric Ulcerative Colitis Activity Index (PUCAI)

Ulcerative colitis (UC) is a disease less expressive than Crohn's disease (CD), but it still poses many unique challenges. The incidence of pediatric-onset UC, which includes approximately 15% to 20% of cases, ranges from 1 -4 in 10,000 patients per year. It’s at an advanced stage in sixty to eighty percent of all cases, two times more than in adults. The presence of exaggerated inflammation differentiates Pediatric-onset ulcerative colitis (UC) from that in adults. Greater inflammation occurring even after the splenic flexure is found in the majority of children and adolescents, increasing in the favor of extreme cases of exacerbations. As we know that the extent of the disease is directly related to the severity of the disease, the pediatric population with UC are in more need of hospitalization if the exacerbations are severe and colectomy is performed for such cases of medically refractory disease, however, reduced colectomy rates are reported as well. In addition to more severe colitis, children also have unique age-related issues, such as growth, pubertal development, nutrition, and bone mineral density accretion, as well as differing psychosocial needs. Despite the mortality rate in pediatric UC being very less now, a more advanced and indirect case of fatality due to infections and cancer was reported in 19 children over six years.

Abdominal Pain

Rectal Bleeding

Stool consistency of most stools

Number of stools per 24 hours

Nocturnal stools (any episode causing wakening)

Activity Level

Result :
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The activity of intestinal inflammation is described by multiple parameters that have been developed and not just one single biochemical attribute. Despite Crohn’s disease (CD) activity indices being accepted, it is generally used to evaluate adult CD trials and not the pediatric population having CD. Thus after several pieces of research and studies, The Pediatric Crohn’s Disease Activity Index (PCDAI) came to be used to predict disease activity in childhood CD. And similarly, for ulcerative colitis in 2007, a Pediatric UC Activity Index (the PUCAI) was created and proven to evaluate potentially signed cohorts of pediatrics UC. Recently, the FDA endorsed the PUCAI for replacing endoscopic assessment for the first-line diagnosis in a pediatric trial consisting of a 5-aminosalicylate (5-ASA) regimen. The PUCAI should be used to monitor the ulcerative colitis regularly with each visit, and treatment should be given in accordance with the evaluation.

The PUCAI calculator is essentially used to evaluate IBDs and assess the pediatric population having UC. The PUCAI is apt for prolonged use in clinical trials and for predicting accurately severe acute UC when introducing second-line therapy. It was made to be suited appropriately for children and doesn’t have any side effects from the endoscopic inflammatory action and has high efficiency and response to treatment as studies and trials have proved. It is currently being incorporated in the management of acute severe ulcerative colitis by international clinics after its publication due to its high accuracy. The PUCAI is a tool helpful in acting as a first-line diagnostic treatment of pediatric UC in combination with endoscopic assessment or even as the only scoring system if suppose the warranty of endoscopy is not feasible. It is pitched to be used as a calculative measure at the foundation for predicting disease activity as a requirement of criteria of clinical trials and for assessing change over time. The calculator has thus achieved credibility and is seen as a success in reflecting endoscopic diseases

The scores evaluated in the end prove the severity of the disease:

  • severe: 65 or more
  • Moderate: between 35-64
  • Mild: between 10-34
  • The disease is not present: less than 10
Item Category/Points
Abdominal pain No pain = 0
Pain can be ignored = 5
Pain cannot be ignored = 10
Rectal bleeding None = 0
Small amount only, in less than 50% of stools = 10
Small amount with most stools =20
Large amount (50% of the stool content) = 30
Stool consistency of most stools Formed = 0
Partially formed = 5
Completely unformed = 10
Number of stools per 24 hours 0-2 = 0 points
3-5 = 5 points
6-8 = 10 points
>8 = 15 points
Nocturnal stools (any episode causing wakening) no = 0 points
yes = 10 points
Activity Level No limitation of activity = 0
Occasional limitation of activity = 5
Severe restricted activity = 10

There are some people who are more prone to surgery with the conditions such as having a stool frequency more than 8 times in a day, tachycardia, pyrexia, low albumin count, less hemoglobin and high platelet count, colonic dilatation was seen in Xray or C-reactive protein (CRP) greater than 45 mg/liter


Turner D, Otley AR, Mack D, et al. Development and evaluation of a Pediatric Ulcerative Colitis Activity Index (PUCAI): a prospective multicenter study. Gastroenterology. 2007; 133: 423

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