racial and ethnic groups. African Americans with Crohn’s disease are more likely than Caucasians to have disease in the colon or upper GI tract (esophagus, stomach, and first section of the small intestine).16 They are also less likely to have disease in the last section of the small intestine (terminal ileum). African Americans are also more likely to have certain extraintestinal complications, such as uveitis (swelling/ irritation of the eye). Hispanics have a higher prevalence of a skin disorder called erythema nodosum (tender, red nodules beneath the skin). Special Populations IBD can affect men and women of all ages. For certain populations of IBD patients—such as children, women of childbearing age, and older adults—there are special considerations regarding these diseases. Children Most people with IBD are diagnosed after age 15. IBD can be diagnosed at a younger age, although it is rare in children younger than eight years of age. Previous studies estimate that approximately 5% of all IBD cases in the US are of pediatric age (CLINICAL PRACTICE GUIDELINES AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis Joseph D. Feuerstein,1 Kim L. Isaacs,2 Yecheskel Schneider,3 Shazia Mehmood Siddique,3 Yngve Falck-Ytter,4,5 and Siddharth Singh,6 on behalf of the AGA Institute Clinical Guidelines Committee 1 Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 2 Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; 3 Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; 4 Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio; 5 Department of Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio; and 6 Division of Gastroenterology, University of California, San Diego, La Jolla, California This document presents the official recommendations of the American Gastroenterological Association (AGA) on the management of moderate to severe ulcerative colitis (UC). The guideline was developed by the AGA Institute’s Clinical Guidelines Committee and approved by the AGA Governing Board. It is accompanied by a technical review that provides a detailed synthesis of the evidence from which these recommendations were formulated.1 Development of this guideline and the accompanying technical review was fully funded by the AGA Institute without additional outside funding. Members of the guideline panel and technical review panel were selected by the AGA Governing Board in consultation with the Clinical Guidelines Committee with careful consideration of all Institute of Medicine recommendations for clinical guideline development. Joseph Feuerstein was the guideline panel chair and Siddharth Singh was the methodologist and co-chair of the guideline panel. A patient representative was also included in the development and review process and had no recommended changes. The guideline and accompanying technical review underwent independent peer review, and a 30-day open public comment period; all comments were collated by the AGA staff, and were reviewed and carefully considered by the guideline panel and technical review teams, respectively. Changes were incorporated in revised documents, and where changes were not accepted, a thoughtful response document was created. After the public comment period, 2 pivotal clinical trials (VARSITY, UNIFI) were published and a critical safety update on tofacitinib was issued by the US Food and Drug Administration (FDA). At the recommendation of the Clinical Guidelines Committee, the technical review and clinical guidelines were updated to incorporate this new evidence as presented here. In accordance with the Clinical Guidelines Committee policies, all clinical guidelines are reviewed annually at the AGA Clinical Guideline Committee meeting for new information. The next update for these guidelines is anticipated in 3 years from publication. UC is a chronic inflammatory bowel disease with peak onset in early adulthood.2 Untreated, the natural history