[Guideline 'Diagnosis and treatment of inflammatory bowel disease in children'].
de Ridder Lissy,Rings Edmond H H M,Escher Johanna C,
Nederlands tijdschrift voor geneeskunde
A multidisciplinary working group has outlined evidence-based practice guidelines for the diagnosis and treatment of inflammatory bowel disease in children (IBD). Both diagnosis and treatment of IBD in children differ significantly from practice in adults. The incidence of IBD in children is low (5.2 per 100,000 per year in the age group 0-17 years), but most of the presenting symptoms are non-specific; therefore it is difficult for the general practitioner to recognise the disease in children. For a correct diagnosis, ileocolonoscopy and upper gastrointestinal endoscopy are necessary, often combined with radiological imaging of the small bowel. In children and adolescents with Crohn's disease, nutritional therapy is the first choice of treatment for remission induction. As maintenance treatment, immunomodulators (azathioprine or mercaptopurine) should be started from the time of initial diagnosis. In children and adolescents with ulcerative colitis, the first treatment is with aminosalicylates. Prednisone and/or immunomodulators (azathioprine, cyclosporin) are indicated if there is insufficient response to aminosalicylates. A final treatment option is colectomy. The transition from paediatric to adult health care needs special attention as the patient and his or her parents may be reluctant to change trusted contacts which they have made.
Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease.
Journal of Crohn's & colitis
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.
10.1016/j.crohns.2014.04.005
Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN.
Turner Dan,Travis Simon P L,Griffiths Anne M,Ruemmele Frank M,Levine Arie,Benchimol Eric I,Dubinsky Marla,Alex George,Baldassano Robert N,Langer Jacob C,Shamberger Robert,Hyams Jeffrey S,Cucchiara Salvatore,Bousvaros Athos,Escher Johanna C,Markowitz James,Wilson David C,van Assche Gert,Russell Richard K, ,
The American journal of gastroenterology
OBJECTIVES:Acute severe ulcerative colitis (ASC) is a potentially life-threatening disease. We aimed to formulate guidelines for managing ASC in children based on systematic review of the literature and robust consensus process. This manuscript is a product of a joint effort of the ECCO (European Crohn's and Colitis Organization), the Pediatric Porto Inflammatory Bowel Disease (IBD) Working group of ESPGHAN (European Society of Pediatric Gastroenterology, Hepatology, and Nutrition) and ESPGHAN. METHODS:A group of 19 experts in pediatric IBD participated in an iterative consensus process including two face-to-face meetings. A total of 17 predefined questions were addressed by working subgroups based on a systematic review of the literature. RESULTS:The recommendations and practice points were eventually endorsed with a consensus rate of at least 95% regarding: definitions, initial evaluation, standard therapy, timing of second-line therapy, the role of endoscopic evaluation and heparin prophylaxis, how to administer second-line medical therapy, how to assess response, surgical considerations, and discharge recommendations. A management flowchart is presented based on daily scoring of the Pediatric Ulcerative Colitis Activity Index (PUCAI), along with 28 formal recommendations and 34 practice points. CONCLUSIONS:These guidelines provide clinically useful points to guide the management of ASC in children. Taken together, the recommendations offer a standardized protocol that allows effective monitoring of disease progress and timely treatment escalation when needed.
10.1038/ajg.2010.481
Pediatric Inflammatory Bowel Disease Clinical Innovations Meeting of the Crohn's & Colitis Foundation: Charting the Future of Pediatric IBD.
Picoraro Joseph A,Lee Dale,Heller Caren A,Weaver Alandra,Hyams Jeffrey S,Conklin Laurie S,Otley Anthony,Ziring David,Kugathasan Subra,Rosh Joel R,Mulberg Andrew,Denson Lee A,Kappelman Michael D,Grossman Andrew B,Bousvaros Athos,Park K T
Inflammatory bowel diseases
The Crohn's & Colitis Foundation has facilitated transformational research in pediatric inflammatory bowel disease (IBD), through the RISK and PROTECT studies, that has laid the groundwork for a comprehensive understanding of molecular mechanisms of disease and predictors of therapeutic response in children. Despite these advances, children have lacked timely and informed access to the latest therapeutic advancements in IBD. The Crohn's & Colitis Foundation convened a Pediatric Resource Organization for Kids with Inflammatory Intestinal Diseases (PRO-KIIDS) Clinical Innovations Meeting at the inaugural Crohn's and Colitis Congress in January 2018 to devise how to advance the care of children with IBD. The working group selected 2 priorities: (1) accelerating therapies to children with IBD and (2) stimulating investigator-initiated research while fostering sustainable collaboration; and proposed 2 actions: (a) the convening of a task force to specifically address how to accelerate pharmacotherapies to children with IBD and (b) the funding of a multicenter clinical and translational research study that incorporates the building of critical research infrastructure.10.1093/ibd/izy205_video1izy205.video15799266615001.
10.1093/ibd/izy205