1. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease
- Author
-
B Weiss, L. de Ridder, J. Amil Dias, Dan Turner, Sibylle Koletzko, Frank M. Ruemmele, Arrigo Barabino, Paolo Lionetti, Erasmo Miele, A Eliakim, Anders Paerregaard, Jean-Pierre Hugot, Christian Braegger, V.M. Navas Lopez, Richard K Russell, Sanja Kolaček, Gigi Veereman, Javier Martín-de-Carpi, Harland S. Winter, Jiri Bronsky, Jaroslaw Kierkus, Axel Dignass, Ron Shaoul, Gábor Veres, Ulrika L. Fagerberg, P. van Rheenen, Anne Griffiths, Daniela Elena Serban, David Wilson, Kaija-Leena Kolho, Johanna C. Escher, Stephan Buderus, Arie Levine, Center for Liver, Digestive and Metabolic Diseases (CLDM), Ruemmele, Fm, Veres, G, Kolho, Kl, Griffiths, A, Levine, A, Escher, Jc, Amil Dias, J, Barabino, Lorenza, Braegger, Cp, Bronsky, J, Buderus, S, Martín-de-Carpi, J, De Ridder, L, Fagerberg, Ul, Hugot, Jp, Kierkus, J, Kolacek, S, Koletzko, S, Lionetti, P, Miele, E, Navas López, Vm, Paerregaard, A, Russell, Rk, Serban, De, Shaoul, R, Van Rheenen, P, Veereman, G, Weiss, B, Wilson, D, Dignass, A, Eliakim, A, Winter, H, Turner, D, Interne Geneeskunde, RS: NUTRIM - R2 - Gut-liver homeostasis, MUMC+: MA Maag Darm Lever (9), F.M. Ruemmele, G. Vere, K.L. Kolho, A. Griffith, A. Levine, J.C. Escher, J. Amil Dia, A. Barabino, C.P.a Braegger, J. Bronsky, S. Buderu, J. Martín-de-Carpi, L. De Ridder, U.L. Fagerberg, J.P. Hugot, J. Kierku, S. Kolacek, S. Koletzko, P. Lionetti, E. Miele, V.M. Navas López, A. Paerregaard, R.K. Russell, D.E. Serban, R. Shaoul, P. Van Rheenen, G. Veereman, B. Wei, D. Wilson, A. Digna, A. Eliakim, H. Winter, D. Turner, [The following ECCO National Representatives participated in the review process of this consensus: Italy, Paolo Gionchetti, ], University of Zurich, Ruemmele, F M, and Pediatrics
- Subjects
Medical therapy ,POPULATION-BASED COHORT ,Azathioprine ,Disease ,Guideline ,Inflammatory bowel disease ,law.invention ,Randomized controlled trial ,Maintenance therapy ,Crohn Disease ,law ,Adrenal Cortex Hormones ,Medicine ,Child ,DEVELOP REGISTRY DATA ,Pediatric ,Crohn's disease ,Mercaptopurine ,Anti-Inflammatory Agents, Non-Steroidal ,Remission Induction ,Gastroenterology ,Antibodies, Monoclonal ,General Medicine ,3. Good health ,Anti-Bacterial Agents ,Thalidomide ,Algorithms ,Immunosuppressive Agents ,medicine.drug ,medicine.medical_specialty ,Adolescent ,NEWLY-DIAGNOSED CHILDREN ,610 Medicine & health ,NONMELANOMA SKIN CANCERS ,Guidelines ,Antibodies, Monoclonal, Humanized ,Maintenance Chemotherapy ,Enteral Nutrition ,Adalimumab ,Humans ,2715 Gastroenterology ,EXCLUSIVE ENTERAL NUTRITION ,Intensive care medicine ,PLACEBO-CONTROLLED TRIALS ,TERM-FOLLOW-UP ,SINGLE-CENTER COHORT ,business.industry ,Tumor Necrosis Factor-alpha ,medicine.disease ,Infliximab ,Surgery ,Aminosalicylic Acids ,Methotrexate ,10036 Medical Clinic ,RANDOMIZED-CONTROLLED-TRIAL ,business ,INFLAMMATORY-BOWEL-DISEASE - Abstract
Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition. The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutrition (EEN) is the induction therapy of first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission. The majority of patients with pediatric-onset CD require immunomodulator based maintenance therapy. The experts discuss several factors potentially predictive for poor disease outcome (such as severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, persistent severe disease despite adequate induction therapy), which may incite to an anti-TNF-based top down approach. These guidelines are intended to give practical (whenever possible evidence-based) answers to (pediatric) gastroenterologists who take care of children and adolescents with CD; they are not meant to be a rule or legal standard, since many different clinical scenario exist requiring treatment strategies not covered by or different from these guidelines.
- Published
- 2014