RT Journal Article
T1 The Medical Management of Paediatric Crohn's Disease: an ECCO-ESPGHAN Guideline Update.
A1 van Rheenen, Patrick F
A1 Aloi, Marina
A1 Assa, Amit
A1 Bronsky, Jiri
A1 Escher, Johanna C
A1 Fagerberg, Ulrika L
A1 Gasparetto, Marco
A1 Gerasimidis, Konstantinos
A1 Griffiths, Anne
A1 Henderson, Paul
A1 Koletzko, Sibylle
A1 Kolho, Kaija-Leena
A1 Levine, Arie
A1 van Limbergen, Johan
A1 Martin de Carpi, Francisco Javier
A1 Navas-López, Víctor Manuel
A1 Oliva, Salvatore
A1 de Ridder, Lissy
A1 Russell, Richard K
A1 Shouval, Dror
A1 Spinelli, Antonino
A1 Turner, Dan
A1 Wilson, David
A1 Wine, Eytan
A1 Ruemmele, Frank M
K1 Crohn’s disease/therapy
K1 Practice guideline
K1 algorithms
K1 child
AB We aimed to provide an evidence-supported update of the ECCO-ESPGHAN guideline on the medical management of paediatric Crohn's disease [CD]. We formed 10 working groups and formulated 17 PICO-structured clinical questions [Patients, Intervention, Comparator, and Outcome]. A systematic literature search from January 1, 1991 to March 19, 2019 was conducted by a medical librarian using MEDLINE, EMBASE, and Cochrane Central databases. A shortlist of 30 provisional statements were further refined during a consensus meeting in Barcelona in October 2019 and subjected to a vote. In total 22 statements reached ≥ 80% agreement and were retained. We established that it was key to identify patients at high risk of a complicated disease course at the earliest opportunity, to reduce bowel damage. Patients with perianal disease, stricturing or penetrating behaviour, or severe growth retardation should be considered for up-front anti-tumour necrosis factor [TNF] agents in combination with an immunomodulator. Therapeutic drug monitoring to guide treatment changes is recommended over empirically escalating anti-TNF dose or switching therapies. Patients with low-risk luminal CD should be induced with exclusive enteral nutrition [EEN], or with corticosteroids when EEN is not an option, and require immunomodulator-based maintenance therapy. Favourable outcomes rely on close monitoring of treatment response, with timely adjustments in therapy when treatment targets are not met. Serial faecal calprotectin measurements or small bowel imaging [ultrasound or magnetic resonance enterography] are more reliable markers of treatment response than clinical scores alone. We present state-of-the-art guidance on the medical treatment and long-term management of children and adolescents with CD.
YR 2020
FD 2020-10-07
LK http://hdl.handle.net/10668/16377
UL http://hdl.handle.net/10668/16377
LA en
DS RISalud
RD Apr 17, 2025