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Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease
Open accessAbstract
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.
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“This interest and use of CAM is common in pediatric IBD, despite being limited evidence for the role of diet and other types of CAMs in inducing and maintaining disease remission in IBD (excluding exclusive enteral nutrition in pediatric Crohn’s disease) [22,23,24].”
From Online Acceptance and Commitment Therapy and Nutrition Workshop for Parents of Children with Inflammatory Bowel Disease: Feasibility, Acceptability, and Initial Effectiveness. (2021) · cites this paper as [22]
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“Exclusive enteral nutrition (EEN) and corticosteroids (CS) are both effective treatment options for the induction of remission in pediatric Crohn’s disease (CD), with a clinical remission rate of approximately 80% for both treatments [2,3].”
BackgroundResultDiet and microbiome in the beginning of the sequence of gut inflammation
CEBALLOS, D. S., Hernández-Camba, A., & Ramos, L. (2021) · World Journal of Clinical Cases · doi:10.12998/wjcc.v9.i36.11122 · Cited by 37
Health Care Maintenance for the Pediatric Patient With Inflammatory Bowel Disease
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“Therefore, the distinction between CD and UC is of pivotal importance for tailored clinical management (9,10).”
BackgroundPediatric Home Parenteral Nutrition in France: A six years national survey
Goulet, O., Breton, A. L., Coste, M., Dubern, B., Ecochard‐Dugelay, E., Guimber, D., Loras-Duclaux, I., Abi‐Nader, E., Marinier, E., Peretti, N., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.08.002 · Cited by 35
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“541; ulcerative colitis: 38 [29, 81] vs Controls: 52 pg/mg [27, 109], p = 0.”
MethodCHHAYA, V. A., Pollok, R., Cecil, E. V., Subramanian, V., Ćurčin, V., Majeed, A., & Saxena, S. K. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13361 · Cited by 34
“Current guidance places an emphasis on frequency of relapse or steroid dependent disease prior to the initiation of thiopurines.(6) Our findings suggest children and young adults with CD should be considered for early treatment with these agents.”
BackgroundLipid and Bile Acid Dysmetabolism in Crohn’s Disease
Uchiyama, K., Kishi, H., Komatsu, W., Nagao, M., Ohhira, S., & Kobashi, G. (2018) · Journal of Immunology Research · doi:10.1155/2018/7270486 · Cited by 34
“In parallel, the first choice of therapy in children with Crohn’s disease is exclusive enteral nutrition, which is an induction therapy [4].”
BackgroundNúñez‐Sánchez, M. Á., Melgar, S., O'DONOGHUE, K., Martínez‐Sánchez, M. A., Fernández-Ruiz, V. E., Ferrer‐Gómez, M., Ruiz‐Alcaraz, A. J., & Ramos‐Molina, B. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23158361 · Cited by 38
“Indeed, EEN has been demonstrated to achieve similar results to those obtained with corticosteroid treatment in the patients, with additional benefits such as avoidance of growth retarding and complete coverage of nutritional needs [8,9].”
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Very Early-Onset Inflammatory Bowel Disease: A Challenging Field for Pediatric Gastroenterologists
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“Exclusive enteral nutrition (EEN) is a safe and effective induction therapy for pediatric IBD [35].”
EEN Yesterday and Today … CDED Today and Tomorrow
Herrador‐López, M., Martín‐Masot, R., & Navas‐López, V. M. (2020) · Nutrients · doi:10.3390/nu12123793 · Cited by 33
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Medical and surgical management of perianal Crohn’s disease
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Time‐to‐reach Target Calprotectin Level in Newly Diagnosed Patients With Inflammatory Bowel Disease
Haisma, S., Verkade, H. J., Scheenstra, R., van der Doef, H. P. J., Bodewes, F. A. J. A., & van Rheenen, P. F. (2019) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002458 · Cited by 32
the Italian Society of Colorectal Surgery (SICCR), Pellino, G., Keller, D. S., Sampietro, G. M., Annese, V., Carvello, M., Celentano, V., Coco, C., Colombo, F., Cracco, N., et al. (2020) · Techniques in Coloproctology · doi:10.1007/s10151-019-02145-0 · Cited by 32
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“It is still the therapeutic modality of choice for treating the first flare-up of paediatric luminal Crohn’s disease (CD) [1].”
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Bertani, L., Ribaldone, D. G., Bellini, M., Mumolo, M. G., & Costa, F. (2021) · Nutrients · doi:10.3390/nu13041387 · Cited by 38
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“It has been demonstrated that dietary therapy can result in rapid change within a week in the intestinal microbial profile of children with CD (Lewis et al., 2015) and induction of remission of CD is possible with exclusive enteral nutrition (Ruemmele et al., 2014).”
BackgroundWintzell, V., Svanström, H., Olén, O., Melbye, M., Ludvigsson, J. F., & Pasternak, B. (2019) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(18)30401-2 · Cited by 31
Inflammatory Bowel Diseases: Host-Microbial-Environmental Interactions in Dysbiosis
Colquhoun, C. M., Duncan, M., & Grant, G. (2020) · Diseases · doi:10.3390/diseases8020013 · Cited by 33
“To date, the primary dietary regime used for the treatment of pediatric CD is exclusive enteral nutrition (EEN) [59,60].”
BackgroundMultiomic features associated with mucosal healing and inflammation in paediatric Crohn’s disease
Taylor, H., Serrano-Contreras, J. I., McDonald, J. A. K., Epstein, J., Fell, J. M. E., Seoane, R. C., Li, J. V., Marchesi, J. R., & Hart, A. L. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16086 · Cited by 31
“Children with CD typically have more aggressive disease and worse long-term outcomes than those with adult onset disease.(1) Treatment of paediatric CD aims to control symptoms and to suppress mucosal inflammation.”
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Pediatric Management of Crohn’s Disease
Mitchel, E. B., & Rosh, J. R. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2021.12.013 · Cited by 31
Schulman, J. M., Pritzker, L., & Shaoul, R. R. (2017) · Canadian Journal of Gastroenterology and Hepatology · doi:10.1155/2017/5873158 · Cited by 31
“In addition, the oneyear maintenance of remission is around 30% and 60% for methotrexate and azathioprine, respectively [4].”
BackgroundIncreased duodenal expression of miR-146a and -155 in pediatric Crohn’s disease
Szűcs, D., Beres, N. J., Rokonay, R., Boros, K. K., Borka, K., Kiss, Z., Arató, A., Szabo, A. J., Vannay, Á., Sziksz, E., et al. (2016) · World Journal of Gastroenterology · doi:10.3748/wjg.v22.i26.6027 · Cited by 30
Less Anti‐infliximab Antibody Formation in Paediatric Crohn Patients on Concomitant Immunomodulators
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Inflammatory Bowel Diseases and School Absenteeism
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“Exclusive Enteral Nutrition (EEN) is the most common treatment for paediatric CD in the UK and the rest of Europe [3].”
BackgroundSharma, S., Gupta, A., Kedia, S., Agarwal, S., Singh, N., Goyal, S., Jain, S., Gupta, V., Sahu, P., Vuyyuru, S. K., et al. (2020) · Intestinal Research · doi:10.5217/ir.2019.09172 · Cited by 30
“EEN is already the first line therapy for induction of remission in pediatric CD14 and has even demonstrated better efficacy than steroids in terms of improvements in growth and mucosal healing.26,27 The evidence for adults is heterogeneous, with meta-analyses reporting it as inferior to steroids28 and recent case ser…”
BackgroundInfluentialPositioning Biologic Therapies in the Management of Pediatric Inflammatory Bowel Disease.
Breton, J., Kastl, A., Conrad, M. A., & Baldassano, R. N. (2020) · PubMed Central · Cited by 30
Nutritional therapy in inflammatory bowel disease
Shabat, C. S., Boneh, R. S., & Levine, A. (2015) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000178 · Cited by 30
Ziv‐Baran, T., Hussey, S., Sładek, M., Dias, J. A., de Carpi, J. M., Miele, E., Veres, G., Lionetti, P., Koletzko, S., Nuti, F., et al. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15016 · Cited by 29
“Patients were eligible for inclusion following informed parental consent if they were aged 4‐17 years, were newly diagnosed with CD according to combination of clinical, laboratory, endoscopic (gastroscopy and ileocolonoscopy), radiographic and histologic criteria, and had no prior treatments for CD.15–18 Patients wer…”
BackgroundInfluentialPrevalence of allergic diseases in children with inflammatory bowel disease
Wasielewska, Z., Dolińska, A., Wilczyńska, D., Szaflarska‐Popławska, A., & Krogulska, A. (2019) · Advances in Dermatology and Allergology · doi:10.5114/ada.2018.81189 · Cited by 29
“Besides, there is hope that probiotics will soon appear to be beneficial in the treatment of IBD and allergic diseases [2, 40, 41].”
BackgroundInflammatory bowel disease: long-term therapeutic challenges
Ashton, J. J., Green, Z., Kolimarala, V. K., & Beattie, R. M. (2019) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2019.1685872 · Cited by 31
“In addition consensus guidelines and consortium healthcare management systems, such as ImproveCareNow, should result in improved long-term outcomes, alongside benchmarking against other services [96].”
Backgroundvan Rheenen, H., & van Rheenen, P. F. (2020) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2020.23.2.121 · Cited by 29
Naqvi, S. A., Taylor, L., Panaccione, R., Ghosh, S. K., Barkema, H. W., Hotte, N., Shommu, N. S., Kaur, S., Reimer, R. A., Madsen, K. L., et al. (2021) · Scientific Reports · doi:10.1038/s41598-020-80924-8 · Cited by 34
Peripheral neuropathy: An underreported neurologic manifestation of inflammatory bowel disease
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“Thalidomide is used in clinical practice as third line therapy to maintain remission in CD [50–52].”
MethodStrisciuglio, C., Bellini, G., Miele, E., Martinelli, M., Cenni, S., Tortora, C., Tolone, C., del Giudice, E. M., & Rossi, F. (2016) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000755 · Cited by 29
Hyams, J. S., Dubinsky, M. C., Rosh, J. R., Ruemmele, F. M., Eichner, S. F., Maa, J., Lazar, A., Alperovich, G., Mostafa, N. M., & Robinson, A. M. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15054 · Cited by 28
“Current guidelines suggest that immunomodulators may be discontinued after 6 months of combination therapy in patients who achieved complete remission with mucosal healing.(14) TABLE 3 Patients with treatment‐emergent AEs by baseline IMM use (safety population)”
BackgroundResultInfluentialPark, S., Kang, Y., Koh, H., & Kim, S. (2020) · Korean Journal of Pediatrics · doi:10.3345/cep.2019.00500 · Cited by 28
“However, they showed no statis tically significant impact for treating CD.70,71) In addition, several microbes such as Faecalibacterium prausnitzii and Bac teroides fragilis have been studied for their therapeutic poten tial as they seem to reduce colitis severity in many mouse models.7274) As shown above, some taxa s…”
BackgroundInfluentialKowalska‐Duplaga, K., Kapusta, P., Gosiewski, T., Sroka-Oleksiak, A., Ludwig‐Słomczyńska, A. H., Wołkow, P. P., & Fyderek, K. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9030687 · Cited by 28
“Infliximab (IFX), a chimeric anti-TNF-α antibody, is widely used in the treatment of pediatric patients with CD [21,22].”
BackgroundIndirect Costs and Family Burden of Pediatric Crohnʼs Disease in the United States
Kahn, S. A., Lin, C.-W., Ozbay, B. A., Wang, A., Chao, J., & Skup, M. (2017) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000001268 · Cited by 28
Exclusive Enteral Nutrition versus Infliximab in Inducing Therapy of Pediatric Crohn’s Disease
Luo, Y., Yu, J., Lou, J., Fang, Y., & Chen, J. (2017) · Gastroenterology Research and Practice · doi:10.1155/2017/6595048 · Cited by 28
Rocha, A., Bessa, I., Lago, P. M., Santos, M. D., Leite, J., & Castro-Poças, F. (2018) · GE Portuguese Journal of Gastroenterology · doi:10.1159/000494674 · Cited by 28
Franca, R., Curci, D., Lucafò, M., Decorti, G., & Stocco, G. (2019) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2019.1630378 · Cited by 28
“For patients under 40 kg, dosing regimens may be reduced to 80–4020 mg; in patients losing response or with low trough levels, weekly injections should be considered [64].”
BackgroundInfluentialWang, X., Lang, F., & Liu, D. (2024) · Biology · doi:10.3390/biology13090674 · Cited by 30
Gale, G., Sigurdsson, G. V., Östman, S., Malmborg, P., Högkil, K., Hasséus, B., Jontell, M., & Saalman, R. (2016) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000670 · Cited by 27
“OFG, granuloma formation occurs in 70% to 100% of the oral lesions, irrespective of coexisting CD.3,8,16,19 Variations in the NOD2 gene are known to confer a considerably increased risk for CD,20,21 and the frequencies of such polymorphisms show geographic variations.22–25 NOD2 gene variations have not specifically be…”
BackgroundInfluentialvon Allmen, D. (2018) · Clinics in Colon and Rectal Surgery · doi:10.1055/s-0037-1609022 · Cited by 27
Levine, A., Chanchlani, N., Hussey, S., Ziv‐Baran, T., Escher, J. C., Dias, J. A., Veres, G., Koletzko, S., Turner, D., Kolho, K.-L., et al. (2019) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjz111 · Cited by 27
Infectious and digestive complications in glycogen storage disease type Ib: Study of a French cohort
Wicker, C., Roda, C., Perry, A., Arnoux, J. B., Brassier, A., Castelle, M., Servais, A., Donadieu, J., Bouchereau, J., Pigneur, B., et al. (2020) · Molecular Genetics and Metabolism Reports · doi:10.1016/j.ymgmr.2020.100581 · Cited by 27
Hensel, K. O., Kyrana, E., Hadžić, N., Mann, J. P., Mieli‐Vergani, G., Gasparetto, M., Heuschkel, R. B., Noble-Jamieson, G., & Samyn, M. (2021) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2021.07.047 · Cited by 27
Calzada‐Hernández, J., Antón, J., de Carpi, J. M., López‐Montesinos, B., Penadés, I. C., Donat, E., Cuadros, E. N., Alonso, J. B., Mellado, M. J., Baquero‐Artigao, F., et al. (2022) · European Journal of Pediatrics · doi:10.1007/s00431-022-04640-3 · Cited by 27
“TNF-α inhibitor therapy has changed the natural clinical course of many pediatric IMID patients, especially those with severe disease [5, 6].”
BackgroundSymptoms suggestive of cow's milk allergy in infancy and pediatric inflammatory bowel disease
Virta, L. J., Kautiainen, H., & Kolho, K. (2016) · Pediatric Allergy and Immunology · doi:10.1111/pai.12551 · Cited by 27
“So far, though, there is no effective dietary therapy for IBD, except for the exclusive enteral nutrition used to treat pediatric CD (7, 8).”
BackgroundPraško, J. P., Jelenova, D., Ocisková, M., Látalová, K., Karásková, E., Hrubý, R., Kamarádová, D., & Mihál, V. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s104260 · Cited by 27
Ballester, M. P., Boscá-Watts, M. M., & Mínguez, M. (2018) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2018.05.006 · Cited by 27
Nikkonen, A., & Kolho, K. (2019) · Acta Paediatrica · doi:10.1111/apa.15026 · Cited by 27
Fabián, O., Bajer, L., Drastich, P., Harant, K., Sticová, E., Ďásková, N., Módos, I., Tichánek, F., & Cahová, M. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24119386 · Cited by 27
“For instance, patients with CD are usually initiated via corticosteroids or exclusive enteral nutrition [105,106], whereas UC patients are treated using local or systemic 5-aminosalicylic acid [107].”
BackgroundVernon‐Roberts, A., Chan, P., Christensen, B., Havrlant, R., Giles, E. M., & Williams, A. (2024) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izae087 · Cited by 26
Wilson, D. C., & Russell, R. K. (2017) · Seminars in Pediatric Surgery · doi:10.1053/j.sempedsurg.2017.10.002 · Cited by 26
“A key series of ECCOESPGHAN clinical guidelines include consensus management of paediatric acute severe UC (24), UC (25) and Crohn’s disease (26).”
BackgroundSelinger, C. P., Ochieng, A., George, V., & Leong, R. W. L. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy309 · Cited by 26
Fecal calprotectin in healthy children aged 4–16 years
Roca, M., Rodríguez-Varela, A., Carvajal, E., Donat, E., Cano, F., Armisen, A., Vaya, M. J., Ekoff, H., Hervás, D., Rydell, N., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-77625-7 · Cited by 26
Haisma, S. M., Lijftogt, T., Kindermann, A., Damen, G. M., de Ridder, L., Escher, J. C., Mearin, M. L., de Meij, T. G. J., Hendriks, D. M., George, E., et al. (2015) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjv031 · Cited by 26
Hukkinen, M., Pakarinen, M. P., Merras‐Salmio, L., Koivusalo, A., Rintala, R. J., & Kolho, K. (2016) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2016.01.017 · Cited by 26
Glucocorticoid treatment and adrenal suppression in children: current view and open issues
Improda, N., Chioma, L., Capalbo, D., Bizzarri, C., & Salerno, M. (2024) · Journal of Endocrinological Investigation · doi:10.1007/s40618-024-02461-9 · Cited by 28
Cozijnsen, M. A., Escher, J. C., Griffiths, A. M., Turner, D., & de Ridder, L. (2015) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000245 · Cited by 25
“RCT 2010 Colombel et al (SONIC)(11) Adult CD, moderate-tosevere disease 508 [1] IFX + AZA [2] IFX + PCB [3] AZA + PCB 26 wk CFCR week 26 [1] 96/169 (57%) versus [2] 75/169 (44%), P 1⁄4 0.”
BackgroundMethodInfluentialBiological therapy in pediatric age
Penagini, F., Cococcioni, L., Pozzi, E., Dilillo, D., Rendo, G., Mantegazza, C., & Zuccotti, G. (2020) · Pharmacological Research · doi:10.1016/j.phrs.2020.105120 · Cited by 25
Yamamoto, M., Shanmuganathan, M., Hart, L., Pai, N., & Britz‐McKibbin, P. (2021) · Metabolites · doi:10.3390/metabo11040245 · Cited by 25
“However, two children with UC did not respond to CS therapy; this was not observed in patients who received EEN, which is recommended for all newly diagnosed children with CD [5].”
BackgroundCurrent recommendations on the role of diet in the aetiology and management of IBD
Gerasimidis, K., Godny, L., Boneh, R. S., Svolos, V., Wall, C. L., & Halmos, E. P. (2021) · Frontline Gastroenterology · doi:10.1136/flgastro-2020-101429 · Cited by 26
Nakase, H., Esaki, M., Hirai, F., Kobayashi, T., Matsuoka, K., Matsuura, M., Naganuma, M., Saruta, M., Tsuchiya, K., Uchino, M., et al. (2023) · Journal of Gastroenterology · doi:10.1007/s00535-023-01958-z · Cited by 25
Drug resistance in inflammatory bowel diseases
Moreau, J., & Mas, E. (2015) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2015.11.003 · Cited by 25
Church, P. C., Hyams, J. S., Ruemmele, F. M., de Ridder, L., Turner, D., & Griffiths, A. M. (2018) · Canadian Journal of Gastroenterology and Hepatology · doi:10.1155/2018/3190548 · Cited by 25
Courbette, O., Aupiais, C., Viala, J., Hugot, J., Roblin, X., Candon, S., Louveau, B., Chatenoud, L., & Martinez‐Vinson, C. (2019) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002536 · Cited by 25
Kang, B., Choi, S. Y., Choi, Y. O., Kim, M., Kim, K., Lee, J. H., & Choe, Y. H. (2018) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjy021 · Cited by 24
The burden of digestive disease across Europe: Facts and policies
O’Morain, N. R., & O'Morain, C. A. (2018) · Digestive and Liver Disease · doi:10.1016/j.dld.2018.10.001 · Cited by 24
Successful Transition from Pediatric to Adult Care in Inflammatory Bowel Disease: What is the Key?
Kim, J., & Ye, B. D. (2019) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2019.22.1.28 · Cited by 24
“remission in pediatric-onset CD patients with active luminal disease [51].”
BackgroundMucosal healing in Crohn’s disease: new insights
Cucchiara, S., D’Arcangelo, G., Isoldi, S., Aloi, M., & Stronati, L. (2020) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2020.1759416 · Cited by 24
“This endoscopic feature is also reported in the guidelines for pediatric CD among the factors predictive of poor outcome and, therefore, requiring a top-down therapy approach [17].”
BackgroundКорниенко, Е. А., Хавкин, А. И., Федулова, Э. Н., Васильевна, В. Г., Gabruskaya, T. V., Андреевна, С. Т., Nikitin, A. V., Николаевна, С. Т., Георгиевна, Ц. Е., & Shcherbakova, O. V. (2019) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-171-11-100-134 · Cited by 24
“Примерно у четверти детей с БК обнаруживаются внекишечные проявления болезни [2] (табл.”
InfluentialHöyhtyä, M., Korpela, K., Saqib, S., Junkkari, S., Nissilä, E., Nikkonen, A., Dikareva, E., Salonen, A., de Vos, W. M., & Kolho, K. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izac182 · Cited by 24
Xiao, F., Gao, X., Hu, H., Le, J., Chen, Y., Shu, X., Liang, Z., Xu, Y., Wang, Y., & Zhang, T. (2022) · Nutrients · doi:10.3390/nu14214463 · Cited by 25
“7% (11/12) of pediatric CD patients achieved clinical remission, and 75% (9/12) achieved endoscopic remission, which was similar to previous studies [10,13,15].”
BackgroundResultLv, Y., Lou, Y., Liu, A., Cheng, Q., Yang, G., Xu, C., Luo, Y., Lou, J., Yu, J., Fang, Y., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.11.018 · Cited by 26
Nordenvall, C. A. M., Rosvall, O., Bottai, M., Everhov, A. H., Malmborg, P., Smedby, K. E. E., Ekbom, A., Askling, J., Ludvigsson, J. F., Myrelid, P., et al. (2017) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjx132 · Cited by 24
Mack, D. R., Benchimol, E. I., Critch, J., deBruyn, J. C. C., Tse, F., Moayyedi, P., Church, P. C., Deslandres, C., El‐Matary, W., Huynh, H. Q., et al. (2018) · Journal of the Canadian Association of Gastroenterology · doi:10.1093/jcag/gwz018 · Cited by 24
Tran, L., & Mulligan, K. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy299 · Cited by 22
Emerging strategy towards mucosal healing in inflammatory bowel disease: what the future holds?
Wang, M., Shi, J., Yu, C., Zhang, X., Xu, G., Xu, Z., & Ma, Y. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1298186 · Cited by 25
“The ef fi cacy of enteral nutrition treatment modalities has been partially demonstrated, with exclusive enteral nutrition (EEN) serving as a primary therapeutic approach for pediatric patients with CD, effectively alleviating clinical symptoms and promoting mucosal healing (84).”
BackgroundPerianal Crohn's Disease in Children and Adolescents
Mutanen, A., & Pakarinen, M. P. (2020) · European Journal of Pediatric Surgery · doi:10.1055/s-0040-1716724 · Cited by 23
de Sire, R., Nardone, O. M., Testa, A., Calabrese, G., Caiazzo, A., & Castiglione, F. (2021) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s267172 · Cited by 29
“A fall of inflammatory biomarkers has been observed after the first two weeks of treatment.(16,56) Notably, once remission is achieved, the recommendation to use EEN ceases; however, EN can be used in case of malnutrition.”
Background
Metadata
- Authors
- Ruemmele, F. M., Veres, G., Kolho, K. L., Griffiths, A., Levine, A., Escher, J. C., Amil Dias, J., Barabino, A., Braegger, C. P., Bronsky, J., Buderus, S., Martín-de-Carpi, J., De Ridder, L., Fagerberg, U. L., Hugot, J. P., Kierkus, J., Kolacek, S., Koletzko, S., Lionetti, P., Miele, E., Navas López, V. M., Paerregaard, A., Russell, R. K., Serban, D. E., Shaoul, R., Van Rheenen, P., Veereman, G., Weiss, B., Wilson, D., Dignass, A., Eliakim, A., Winter, H., & Turner, D.
- Affiliations
- Hôpital Necker-Enfants Malades (FR)
- Semmelweis University (HU)
- Helsinki University Hospital (FI)
- University of Toronto (CA)
- Tel Aviv University (IL)
- Erasmus MC (NL)
- Unit of Paediatric Gastroenterology, Hospital S. João, A Hernani Monteiro, 4202-451, Porto, Portugal
- Istituto Giannina Gaslini (IT)
- University Children's Hospital Zurich (CH)
- Department of Pediatrics, University Hospital Motol, Uvalu 84, 150 06 Prague, Czech Republic
- St. Marien-Hospital Bonn (DE)
- Department of Paediatric Gastroenterolgoy, Hepatology and Nutrition, Hospital Sant Joan de Déu, Paseo Sant Joan de Déu 2, 08950 Barcelona, Spain
- Department of Paediatric Gastroenterology, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, Netherlands
- Karolinska Institutet (SE)
- Sorbonne Paris Cité (FR)
- Department of Gastroenterology, Hepatology and Feeding Disorders, Instytut Pomnik Centrum Zdrowia Dziecka, Ul. Dzieci Polskich 20, 04-730 Warsaw, Poland
- Department of Paediatric Gastroenterology, Children's Hospital, University of Zagreb Medical School, Klaićeva 16, 10000 Zagreb, Croatia
- Department of Paediatric Gastroenterology, Dr. von Hauner Children's Hospital, Lindwurmstr. 4, 80337 Munich, Germany
- Meyer Children's Hospital (IT)
- University of Naples Federico II (IT)
- Paediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Avda. Arroyo de los Ángeles s/n, 29009 Málaga, Spain
- Department of Paediatrics 460, Hvidovre University Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark
- Department of Paediatric Gastroenterology, Yorkhill Hospital, Dalnair Street, Glasgow G3 8SJ, United Kingdom
- Iuliu Hațieganu University of Medicine and Pharmacy (RO)
- Rambam Health Care Campus (IL)
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, Netherlands
- Queen Fabiola Children's University Hospital (BE)
- Sheba Medical Center (IL)
- Royal Hospital for Sick Children (GB)
- Agaplesion Markus Hospital (DE)
- Massachusetts General Hospital (US)
- Hebrew University of Jerusalem (IL)
- Corresponding author
- Ruemmele, F.M.
- ORCID
- Venue
- Journal of Crohn s and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-01
- Volume
- 8
- Issue
- 10
- Pages
- 1179-1207
- ISSN
- 1873-9946 (ISSN-L)
- 1876-4479
- OpenAlex
- W2135936774
- Cited by
- 1,083
- References
- 293
- Citations by year
- 2026: 61 · 2025: 60 · 2024: 71 · 2023: 97 · 2022: 83 · 2021: 123 · 2020: 117 · 2019: 136 · 2018: 92 · 2017: 122 · 2016: 61 · 2015: 52 · 2014: 5
- FWCI
- 52.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Crohn s and Colitis (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by-nc-nd)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Surgery › Anorectal Disease Treatments and Outcomes
- Keywords
- pediatric Crohn's disease, medical management
- MeSH terms
- Adalimumab, Infliximab, Adolescent, Adrenal Cortex Hormones, Algorithms, Aminosalicylic Acids, Anti-Inflammatory Agents, Non-Steroidal, Anti-Bacterial Agents, Antibodies, Monoclonal, Azathioprine, Child, Crohn Disease, Enteral Nutrition, Humans, Immunosuppressive Agents, Methotrexate, Remission Induction, Thalidomide, Tumor Necrosis Factor-alpha, Mercaptopurine, Maintenance Chemotherapy, Antibodies, Monoclonal, Humanized
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