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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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Cites
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Cuomo, M., Carobbio, A., Aloi, M., Alvisi, P., Banzato, C., Bosa, L., Bramuzzo, M., Campanozzi, A., Catassi, G. N., D’Antiga, L., et al. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izac215 · Cited by 24
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“Several studies showed that this form of therapy does not associate with any side effects and leads to the recovery of linear growth.6-8 Consequently, the United Kingdom and many centers across Europe started recently using enteral nutrition to treat active CD. Subsequent studies then showed that nutritional therapy m…”
BackgroundInfluentialPediatric inflammatory bowel disease
Kapoor, A., Bhatia, V., & Sibal, A. (2016) · Indian Pediatrics · doi:10.1007/s13312-016-0975-0 · Cited by 23
“EEN is of questionable significance in children with severe pancolitis, oral and perianal CD [22].”
BackgroundThe Use of 5-Aminosalicylic Acid in Children and Adolescents With Inflammatory Bowel Disease
Sokollik, C., Fournier, N., Rizzuti, D., Braegger, C., Nydegger, A., Schibli, S., & Spalinger, J. H. (2017) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000864 · Cited by 23
Dietary Therapies in Pediatric Inflammatory Bowel Disease
Lane, E. R., Lee, D. Y., & Suskind, D. L. (2017) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2017.08.012 · Cited by 24
Krishnakumar, C., Ballengee, C. R., Liu, C., Kim, M., Baker, S. S., Baldassano, R. N., Cohen, S. A., Crandall, W., Denson, L. A., Dubinsky, M. C., et al. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy363 · Cited by 23
Ağın, M., Yücel, A., Gümüş, M., Yüksekkaya, H. A., & Tümgör, G. (2019) · Medicina · doi:10.3390/medicina55100620 · Cited by 23
“The treatment of the cases with ulcerative colitis and with CD is regulated according to ECCO/ESPGHAN recommendations [10,11].”
MethodAtia, O., Shavit-Brunschwig, Z., Lev‐Tzion, R., Stein, R. E., Broide, E., Urlep, D., Hyams, J. S., Weiss, B., Aloi, M., Assa, A., et al. (2025) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(24)00319-4 · Cited by 22
Ashton, J. J., Borca, F., Mossotto, E., Phan, H. T. T., Ennis, S., & Beattie, R. M. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy369 · Cited by 22
Costa-Santos, M. P., Palmela, C., Torres, J., Ferreira, A. S., Velho, S., Ourô, S., Glória, L., Gordo, I., Maio, R., & Cravo, M. L. (2020) · Nutrition · doi:10.1016/j.nutx.2020.100009 · Cited by 22
The role of lymphatics in intestinal inflammation
Hokari, R., & Tomioka, A. (2021) · Inflammation and Regeneration · doi:10.1186/s41232-021-00175-6 · Cited by 23
Pharmacologic Management of Monogenic and Very Early Onset Inflammatory Bowel Diseases
Levine, A. E., Mark, D., Smith, L., Zheng, H. B., & Suskind, D. L. (2023) · Pharmaceutics · doi:10.3390/pharmaceutics15030969 · Cited by 22
Emerging roles of host and microbial bioactive lipids in inflammatory bowel diseases
Kayama, H., & Takeda, K. (2023) · European Journal of Immunology · doi:10.1002/eji.202249866 · Cited by 21
Short-Term Efficacy of Exclusive Enteral Nutrition in Pediatric Crohn’s Disease: Practice in China
Luo, Y., Yu, J., Zhao, H., Lou, J., Chen, F.-B., Peng, K., & Chen, J. (2015) · Gastroenterology Research and Practice · doi:10.1155/2015/428354 · Cited by 22
Hojsak, I., Kolaček, S., Hansen, L. F., Bronský, J., Piekkala, M., Lionetti, P., Škába, R., & Kolho, K. (2015) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2015.03.054 · Cited by 22
“Because of the lack of evidence this statement has not been repeated in the most recent guidelines for themanagement of CD in children [7].”
BackgroundInfluentialGuz‐Mark, A., Rinawi, F., Egotubov, O., Shimon, I., Shamir, R., & Assa, A. (2017) · Digestive and Liver Disease · doi:10.1016/j.dld.2017.01.151 · Cited by 22
Restoration of energy level in the early phase of acute pediatric pancreatitis
Mosztbacher, D., Farkas, N., Solymár, M., Pár, G., Bajor, J., Szűcs, Á., Czimmer, J., Márta, K., Mikó, A., Rumbus, Z., et al. (2017) · World Journal of Gastroenterology · doi:10.3748/wjg.v23.i6.957 · Cited by 22
Bouchard, D., Pigot, F., Staumont, G., Siproudhis, L., Abramowitz, L., Benfredj, P., Brochard, C., Fathallah, N., Faucheron, J. ‐., Higuero, T., et al. (2018) · Techniques in Coloproctology · doi:10.1007/s10151-018-1906-y · Cited by 22
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Kang, B., Kim, T. J., Choi, J., Baek, S., Ahn, S., Choi, R., Lee, S., & Choe, Y. H. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15810 · Cited by 22
Chuong, K. H., Haw, J., Stintzi, A., Mack, D. R., & O’Doherty, K. C. (2019) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2019.1648945 · Cited by 21
“It is recommended as a first-line therapy to induce remission in pediatric CD by an international working group from ESPGHAN and the European Crohn’s and Colitis Organization (ECCO) (Ruemmele et al., 2014).”
BackgroundMethodOptimizing Biologic Agents in Ulcerative Colitis and Crohn’s Disease
O’Toole, A., & Moss, A. C. (2015) · Current Gastroenterology Reports · doi:10.1007/s11894-015-0453-1 · Cited by 21
Dependence of Colonization of the Large Intestine by Candida on the Treatment of Crohn’s Disease
Kowalska‐Duplaga, K., Krawczyk, A., Sroka-Oleksiak, A., Salamon, D., Wędrychowicz, A., Fyderek, K., & Gosiewski, T. (2019) · Polish Journal of Microbiology · doi:10.21307/pjm-2019-014 · Cited by 21
“ECCO/ESPGHAN guidelines recommend the usage of exclusive enteral nutrition (EEN) as a firstline therapy to induce remission in pediatric patients with mild to moderate CD (Ruemmele et al. 2014).”
BackgroundAhn, H. J., Kim, Y., Lee, H., Park, J. H., Hwang, S. W., Yang, D., Ye, B. D., Byeon, J., Myung, S., Yang, S., et al. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.06.026 · Cited by 21
de Sire, R., Nardone, O. M., Testa, A., Calabrese, G., Caiazzo, A., & Castiglione, F. (2021) · Dove Medical Press (Taylor and Francis Group) · Cited by 21
Exclusive enteral nutrition remodels the intestinal flora in patients with active Crohn's disease
Jiang, J., Chen, L., Chen, Y., & Chen, H. (2022) · BMC Gastroenterology · doi:10.1186/s12876-022-02293-y · Cited by 23
“to domestic and foreign guidelines and consensus [5, 6], EEN is one of the preferences for patients with CD, severe cases included, and is the first-line induction therapy for children and adolescents.”
BackgroundGlapa-Nowak, A., Szczepanik, M., Banaszkiewicz, A., Kwiecień, J., Szaflarska‐Popławska, A., Grzybowska‐Chlebowczyk, U., Osiecki, M., Kierkuś, J., Dziekiewicz, M., & Walkowiak, J. (2022) · Medical Science Monitor · doi:10.12659/msm.937842 · Cited by 21
“Corticosteroids were administered according to contemporary European guidelines [43].”
MethodFernandes, P., Sharma, Y., Zulqarnain, F., McGrew, B., Shrivastava, A., Ehsan, L., Payne, D., Dillard, L. R., Powers, D. A., Aldridge, I., et al. (2023) · Scientific Reports · doi:10.1038/s41598-022-26816-5 · Cited by 19
Jongsma, M., Costes, L. M. M., Tindemans, I., Cozijnsen, M. A., Raatgreep, R. C., van Pieterson, M., Li, Y., Escher, J. C., de Ridder, L., & Samsom, J. N. (2023) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjad049 · Cited by 21
Role of diet in prevention versus treatment of Crohn’s disease and ulcerative colitis
Halmos, E. P., Godny, L., Vanderstappen, J., Shabat, C. S., & Svolos, V. (2024) · Frontline Gastroenterology · doi:10.1136/flgastro-2023-102417 · Cited by 22
“However, these findings provide a contradiction to those seen of diet-preventing CD. Outwardly, it would seem that a diet low in fibre, gluten and lactose and inclusive of dairy protein and fat, maltodextrin and UPF treats CD.”
BackgroundInfluentialImmunizations in Pediatric and Adult Patients with Inflammatory Bowel Disease
Long, M. D., Gulati, A., Wohl, D. A., & Herfarth, H. H. (2015) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000395 · Cited by 21
“For moderate to severe CD, EEN remains a viable option and has been endorsed by both European and North American pediatric gastroenterology societies as an alternative to corticosteroid therapy corticosteroid therapy.(16,17) In patients for whom a delay in immunosuppressive therapy is not an option or who present on t…”
BackgroundCurci, D., Lucafò, M., Cifù, A., Bramuzzo, M., Martelossi, S., Favretto, D., Pellegrin, F. D., Fabris, M., Vascotto, F., Naviglio, S., et al. (2019) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002410 · Cited by 21
Role of Thiopurines in Pediatric Inflammatory Bowel Diseases
Atia, O., Ledder, O., Ben‐Moshe, T., Lev‐Tzion, R., Rachmen, Y., Meyer, E. O., Beeri, R., Renbaum, P., Shamasneh, I., Shteyer, E., et al. (2019) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002566 · Cited by 21
“European Society for Paediatric Gastroenterology Hepatology and Nutrition-ECCO guidelines recommend optimizing thiopurines treatment by therapeutic drug monitoring–based dosing, in addition to following clinical response, complete blood count (CBC), and liver enzymes (21,22).”
BackgroundMethodAnti-Mycobacterial Antibiotic Therapy Induces Remission in Active Paediatric Crohn’s Disease
Agrawal, G. K., Hamblin, H. S., Clancy, A. K., & Borody, T. J. (2020) · Microorganisms · doi:10.3390/microorganisms8081112 · Cited by 21
“Oral corticosteroids are used for the induction of remission in moderate to severe paediatric CD cases [5].”
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Lee, W., Briars, L. A., Lee, T. A., Calip, G. S., Suda, K. J., & Schumock, G. T. (2016) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000880 · Cited by 21
Wang, X., Xiao, Y., Xu, X., Yu, Y., Shan, C.-Y., Guo, Y., Gong, L., Zhou, T., Gao, S., Yuan, Y., et al. (2018) · BMC Pediatrics · doi:10.1186/s12887-018-1212-x · Cited by 21
Lawrence, L. S., Heider, A., Singer, A. A. M., Neef, H. C., & Adler, J. (2021) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izab109 · Cited by 20
Diet and gut microbiota manipulation for the management of Crohn's disease and ulcerative colitis
Svolos, V., Gkikas, K., & Gerasimidis, K. (2021) · Proceedings of The Nutrition Society · doi:10.1017/s0029665121002846 · Cited by 20
“Paradoxically, the development of such suppressed and dysbiotic microenvironment coincides with mucosal healing, reduction in colonic inflammatory markers, and disease activity improvement((34)).”
BackgroundAndrade, M. C. J., Muncunill, G. P., Ruf, A. L., Carnero, L. Á., Miravet, V. V., García-Arenas, D., Castillo, N. E., & de Carpi, J. M. (2023) · BMC Gastroenterology · doi:10.1186/s12876-023-02857-6 · Cited by 20
“However, EEN -defined as the oral administration of liquid formula via an enteral tube as the only source of caloric requirements for up to eight weeks - is a highly restrictive approach that can be associated with limited adherence, and it is not suitable for longterm courses [7, 8].”
BackgroundResultInfluentialUrlep, D., Orel, R., Kunstek, P., & Benedik, E. (2023) · Nutrients · doi:10.3390/nu15214676 · Cited by 22
“…(ESPGHAN) and the guidelines of the European Crohn’s and Colitis Organisation (ECCO), either EEN or corticosteroid (CS) therapy can be used for the induction of remission in active paediatric CD; however, EEN is used as a first-line therapy in mild and moderate non-penetrating paediatric CD [19,20].”
BackgroundMethodLarsen, M. D., Baldal, M. E., Nielsen, R. G., Nielsen, J., Lund, K., & Nørgård, B. M. (2016) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365521.2016.1172340 · Cited by 20
“[7] Furthermore, an increasing number of children with IBD are being treated with medical therapies that might be associated with adverse effects not only steroids but also a top-down treatment approach with early use of biologicals in special cases.[8] There has been conflicting results on whether the incidence incre…”
BackgroundChoi, J., Kang, B., Kim, M., Sohn, I., Lee, H. J., & Choe, Y. H. (2018) · Gut and Liver · doi:10.5009/gnl17290 · Cited by 20
“The 2014 ECCO/ESPGHN guideline recommends exclusive EN for at least 68 weeks instead of CS as the first choice for induction in pediatric CD patients.(1) The primary induction with IFX is considered for patients with high risk factors including deep colonic ulceration on endoscopy, extensive (pan-enteric disease), mar…”
MethodBiosimilar infliximab in paediatric inflammatory bowel disease: Efficacy, immunogenicity and safety
Dipasquale, V., & Romano, C. (2020) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/jcpt.13239 · Cited by 20
Pham, T., Sokol, H., Halioua, B., Pourcel, G., Brun, M., Pain, É., & Testa, D. (2021) · BMC Nutrition · doi:10.1186/s40795-021-00446-y · Cited by 20
Lucafò, M., Curci, D., Bramuzzo, M., Alvisi, P., Martelossi, S., Silvestri, T., Guastalla, V., Labriola, F., Stocco, G., & Decorti, G. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.646671 · Cited by 20
“In selected patients, adalimumab was used as first-line treatment (15).”
MethodMaratová, K., Hradský, O., Matysková, J., Čopová, I., Souček, O., Šumnı́k, Z., & Bronský, J. (2017) · European Journal of Pediatrics · doi:10.1007/s00431-017-2988-7 · Cited by 20
“The optimal treatment outcome is to achieve mucosal healing and thus limit the development of secondary complications [2, 3].”
BackgroundGong, W., Guo, K., Zheng, T., Fang, M., Xie, H., Li, W., Hong, Z., Ren, H., Gu, G., Wang, G., et al. (2019) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14240 · Cited by 20
Sood, A., Singh, A., Sudhakar, R., Midha, V., Mahajan, R., Mehta, V., Gupta, Y. K., & Kaur, K. (2020) · Intestinal Research · doi:10.5217/ir.2019.00094 · Cited by 20
“Exclusive enteral nutrition (EEN) involves the use of a complete liquid diet, with exclusion of normal dietary components for a defined period of time, as a therapeutic measure and has an accepted role in induction of remission in active pediatric CD.(13-15) EEN however is not recommended currently for induction of re…”
BackgroundDipasquale, V., Passanisi, S., Cucinotta, U., Cascio, A., & Romano, C. (2021) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-021-01020-9 · Cited by 20
Lee, W. S., Song, Z. L., Wong, S. Y., Gan, C. W., Koay, Z. L., Em, J. M., Chong, S. Y., Lim, C. B., Wong, S. Y., Chew, K. S., et al. (2021) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.15830 · Cited by 19
Outcomes of exclusive enteral nutrition in paediatric Crohn’s disease
Lafferty, L., Tuohy, M., Carey, A., Sugrue, S., Hurley, M. E., & Hussey, S. (2016) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2016.210 · Cited by 19
Diet Therapy for Inflammatory Bowel Diseases: A Call to the Dining Table
Limketkai, B. N., Gordon, M. A., Mutlu, E., de Silva, P. S., & Lewis, J. D. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izz297 · Cited by 19
Rinawi, F., Ricciuto, A., Church, P. C., Frost, K., Crowley, E., Walters, T. D., & Griffiths, A. M. (2020) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaa247 · Cited by 19
The clinical implications of thalidomide in inflammatory bowel diseases
Diamanti, A., Capriati, T., Papadatou, B., Knafelz, D., Bracci, F., Corsetti, T., Elia, D., & Torre, G. (2015) · Expert Review of Clinical Immunology · doi:10.1586/1744666x.2015.1027687 · Cited by 19
“The recent guidelines from European Crohn’s and Colitis Organization/European Society for Pediatric Gastroenterology Hepatology and Nutrition (ECCO/ESPGHAN) conclude that thalidomide cannot be recommended in refractory pediatric Crohn’s disease (CD), but that it may be considered in selected patients who do not tolera…”
BackgroundShaoul, R. R., Brown, S., & Day, A. S. (2017) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001785 · Cited by 19
“EEN with polymeric diet is considered the treatment of choice for induction of remission in children with active CD (3,4).”
BackgroundClinical aspects and treatments for pediatric inflammatory bowel disease
Moon, J. S. (2019) · Intestinal Research · doi:10.5217/ir.2018.00139 · Cited by 18
Pharmacogenetics of Inflammatory Bowel Disease
van den Bosch, B. J. C., & Coenen, M. J. H. (2020) · Pharmacogenomics · doi:10.2217/pgs-2020-0095 · Cited by 18
Gordon–Dixon, A., Gore-Rodney, J., Hampal, R., Ross, R., Miah, A., Adegboye, A. R. A., & Grimes, C. E. (2021) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2021.09.723 · Cited by 18
Targeting Mechano-Transcription Process as Therapeutic Intervention in Gastrointestinal Disorders
Geesala, R., Lin, Y.-M., Zhang, K., & Shi, X.-Z. P. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.809350 · Cited by 18
“, ECCO, ESPGHAN, ESPEN and NASPGHAN) directs clinicians to use EEN to induce remission in young CD patients wherever possible (Critch et al., 2012; Ruemmele et al., 2014; Forbes et al., 2017).”
BackgroundIntestinal Permeability in Children with Functional Gastrointestinal Disorders: The Effects of Diet
Giorgio, V., Margiotta, G., Stella, G., Cicco, F. D., Leoni, C., Proli, F., Zampino, G., Gasbarrini, A., & Onesimo, R. (2022) · Nutrients · doi:10.3390/nu14081578 · Cited by 21
“, Crohn’s disease, as it allows the inflammatory activity to be controlled and may be an alternative to pharmacological treatment [15].”
BackgroundNordestgaard, R. L. M., Wewer, M. D., Malham, M., Wewer, V., Boysen, T., & Burisch, J. M. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18106 · Cited by 18
“18 In the elderly, comorbidities and frailty may delay or even prevent treatment with steroid-sparing medications.”
InfluentialGeesala, R., Gongloor, P., Recharla, N., & Shi, X.-Z. (2024) · Nutrients · doi:10.3390/nu16213581 · Cited by 22
The pharmacotherapeutic management of pediatric Crohn’s disease
Zimmerman, L. A., & Bousvaros, A. (2019) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2019.1659778 · Cited by 18
Immunological Profiling of Paediatric Inflammatory Bowel Disease Using Unsupervised Machine Learning
Coelho, T. A. F., Mossotto, E., Gao, Y., Haggarty, R., Ashton, J. J., Batra, A., Stafford, I. S., Beattie, R. M., Williams, A. P., & Ennis, S. (2020) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002719 · Cited by 18
Perioperative management of ileocecal Crohn’s disease in the current era
Yamamoto, T., Lightner, A. L., Spinelli, A., & Kotze, P. G. (2020) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2020.1802245 · Cited by 18
Yao, J., Jiang, X., & You, J. H. S. (2020) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.15373 · Cited by 18
Kandavel, P., Eder, S. J., Adler, J., & ImproveCareNow Network Pediatric IBD Learning Health System (2021) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003182 · Cited by 18
“Given these risks, reducing corticosteroid use has been a targeted measure for improving the quality of care by multiple pediatric gastrointestinal societies (17,21,22).”
BackgroundGutiérrez, S. G., Navas‐López, V. M., Kolorz, M., Bartošová, L., Lukac, K., Pérez, S. L., Núñez-Caro, L., García-Galán, P., Fernández-Crehuet, F. G., Blasco‐Alonso, J., et al. (2015) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjv086 · Cited by 18
Treatment of perianal Crohn’s disease
Zalieckas, J. M. (2017) · Seminars in Pediatric Surgery · doi:10.1053/j.sempedsurg.2017.10.009 · Cited by 18
Gkikas, K., Logan, M., Nichols, B., Ijaz, U. Z., Clark, C., Svolos, V., Gervais, L., Duncan, H., Garrick, V., Curtis, L., et al. (2021) · BMC Gastroenterology · doi:10.1186/s12876-021-02029-4 · Cited by 17
“Exclusive enteral nutrition (EEN) is the only established dietary treatment for active CD in children [5, 6].”
BackgroundDiet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease
Śledzińska, K., Landowski, P., Zmijewski, M. A., Kamińska, B., Kowalski, K., & Liberek, A. (2022) · Nutrients · doi:10.3390/nu14051029 · Cited by 17
“The ECCO/ESPGHAN recommendations for the treatment of children with IBD emphasize the importance of nutritional treatment, especially in patients with CD [62].”
MethodO’Reilly, C., Mills, S., Rea, M. C., Lavelle, A., Ghosh, S. K., Hill, C., & Ross, R. P. (2023) · Microbiome Research Reports · doi:10.20517/mrr.2023.41 · Cited by 17
“Approved for CD treatment in 2016, it is administered subcutaneously or intravenously.”
Wang, W., Yin, A., Wang, J., Li, J., Cheng, J., Kang, J., Xu, Y., Lu, Y., Yang, Y., Su, J., et al. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.04.013 · Cited by 17
Methotrexate for the Management of Crohn’s Disease in Children
Scherkenbach, L. A., & Stumpf, J. L. (2015) · Annals of Pharmacotherapy · doi:10.1177/1060028015613527 · Cited by 17
“Neither conventional corticosteroids nor budesonide are recommended for long-term therapy.(10,12,13,15) Instead, azathioprine and mercaptopurine are frequently used, although up to 40% of pediatric patients do not respond or fail to tolerate therapy.”
BackgroundMethodInfluentialMouzan, M. I. E., Mofarreh, M. A. A., Saadah, O. I., Al‐Hussaini, A. A., Al-Saleem, K., & Mehaidib, A. A. (2016) · Saudi Journal of Gastroenterology · doi:10.4103/1319-3767.178524 · Cited by 17
Ho, S. S. C., & Day, A. S. (2018) · JGH Open · doi:10.1002/jgh3.12121 · Cited by 17
Dietary Management of Pediatric Inflammatory Bowel Disease
Kaenkumchorn, T. K., & Kesavan, A. (2019) · Journal of Medicinal Food · doi:10.1089/jmf.2019.0063 · Cited by 17
“In a systematic review, EEN was shown to be as effective as corticosteroid therapy in inducing remission in patients with CD. 39 This meta-analysis of five randomized controlled trials of pediatric studies using EEN for CD in a total of 147 children demonstrated that EEN and steroids were of equal efficacy in the induct…”
InfluentialLong-term outcome of immunomodulator use in pediatric patients with inflammatory bowel disease
van Hoeve, K., Hoffman, I. E. A., D’Hoore, A. J. L., Ferrante, M., & Vermeire, S. (2019) · Digestive and Liver Disease · doi:10.1016/j.dld.2019.09.008 · Cited by 17
Diet and nutrition in the management of inflammatory bowel disease
Sahu, P., Kedia, S., Ahuja, V., & Tandon, R. K. (2021) · Indian Journal of Gastroenterology · doi:10.1007/s12664-021-01163-x · Cited by 20
“European and North American guidelines recommend EEN as the 1stline therapy in pediatric patients with active luminal CD [56].”
BackgroundAssa, A., & Shamir, R. (2017) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000402 · Cited by 17
Giugliano, F. P., Strisciuglio, C., Martinelli, M., Andreozzi, M., Cenni, S., Campione, S., D'Armiento, M. R., Staiano, A., & Miele, E. (2017) · Digestive and Liver Disease · doi:10.1016/j.dld.2017.10.017 · Cited by 17
Brückner, A., Werkstetter, K. J., Frivolt, K., Shokry, E., Ahmed, M., Metwaly, A., Júnior, J. G. M., Uhl, O., Krohn, K., Hajji, M. S., et al. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.04.012 · Cited by 17
Kim, E. S., Kwon, Y., Choe, Y. H., & Kim, M. J. (2020) · Scientific Reports · doi:10.1038/s41598-020-75938-1 · Cited by 17
Fecal Calprotectin Test Performed at Home
Piekkala, M., Alfthan, H. V., Merras‐Salmio, L., Puustinen, A., Heiskanen, K., Jaakkola, T., Klemetti, P., Färkkilä, M. A., & Kolho, K. (2017) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001861 · Cited by 16
Nardone, O. M., Calabrese, G., Mantia, A. L., Testa, A., Rispo, A., Alfonsi, L., Pasanisi, F., & Castiglione, F. (2024) · Crohn s & Colitis 360 · doi:10.1093/crocol/otae011 · Cited by 16
Rolandsdotter, H., Jönsson‐Videsäter, K., Fagerberg, U. L., Finkel, Y., & Eberhardson, M. (2019) · Nutrients · doi:10.3390/nu11020414 · Cited by 16
“EEN is recommended to all children with luminal disease, including those with colonic involvement [3].”
BackgroundLawrence, S. J., Sadarangani, M., & Jacobson, K. (2017) · Frontiers in Pediatrics · doi:10.3389/fped.2017.00161 · Cited by 16
Therapeutic drug monitoring of anti-TNF therapy in children with inflammatory bowel disease
van Hoeve, K., Hoffman, I. E. A., & Vermeire, S. (2017) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2018.1413090 · Cited by 16
“fibrosis, fistulas, need for repeated surgical resections, and possibly also cancer [1,2].”
BackgroundHyperadiponectinemia During Infliximab Induction Therapy in Pediatric Crohn Disease
Frivolt, K., Schwerd, T., Schatz, S. B., Freudenberg, F., Prell, C., Werkstetter, K. J., Bufler, P., & Koletzko, S. (2017) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001876 · Cited by 16
“The monoclonal chimeric anti-TNF antibody infliximab (IFX) is a highly effective induction and maintenance treatment in patients with severe and complicated CD (25,26).”
BackgroundLi, G., Wu, X., Gao, X., Lin, R., Chen, L., Sun, M., Jia, J., Liu, Z., Fang, L., & Wu, W. H. (2022) · Food & Function · doi:10.1039/d1fo03579g · Cited by 16
Dalzell, A. M., & Ba’Ath, M. E. (2019) · Paediatrics and International Child Health · doi:10.1080/20469047.2019.1575056 · Cited by 15
“consensus guidelines for the medical management of paediatric CD and UC [54].”
BackgroundStrisciuglio, C., Scarpato, E., Cenni, S., Serra, M. R., Giugliano, F. P., Mainolfi, C. G., Dolce, P., Martinelli, M., Staiano, A., & Miele, E. (2020) · Digestive and Liver Disease · doi:10.1016/j.dld.2020.03.004 · Cited by 15
Stallmach, A., Sturm, A., Dignass, A. U., Kucharzik, T. F., Blumenstein, I., Helwig, U., Koletzko, S., Lynen, P., Schmidt, C., & Collaborators: (2020) · Zeitschrift für Gastroenterologie · doi:10.1055/a-1234-8079 · Cited by 15
Prehabilitation prior to intestinal resection in Crohn’s disease patients: An opinion review
Bak, M. T. J., Ruiterkamp, M. F. E., van Ruler, O., Campmans-Kuijpers, M. J. E., Bongers, B. C., van Meeteren, N. L. U., van der Woude, C. J., Stassen, L. P. S., & de Vries, A. C. (2022) · World Journal of Gastroenterology · doi:10.3748/wjg.v28.i22.2403 · Cited by 15
Adalimumab Therapy in Pediatric Crohn Disease
Payen, E., Neuraz, A., Zenzeri, L., Talbotec, C., Abi‐Nader, E., Chatenoud, L., Chhun, S., Goulet, O., Ruemmele, F. M., & Pigneur, B. (2022) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003643 · Cited by 15
“ADA was administered subcutaneously every 2 weeks with an induction regimen of 2.4 mg/kg (maximum 160 mg) at baseline (M0), 1.2 mg/kg (maximum 80 mg) at week 2 followed by a maintenance treatment every 2 weeks at 0.6 mg/kg (maximum of 40 mg) according to ECCO/ESPGHAN Consensus Guidelines (5).”
BackgroundMethodInfluentialYersinia enterocolitica in Crohn’s disease
Xue, F., Kang, L., Qiu, Y.-F., Li, Z., & Bai, Y. (2023) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2023.1129996 · Cited by 18
“For example, exclusive enteral nutrition (EEN) is used as an effective first-line treatment for inducing remission in pediatric Crohn’s disease (Ruemmele et al., 2014; Levine et al., 2019).”
BackgroundHurych, J., Mascellani, A., Lerchová, T., Hlinakova, L., Kubat, M., Malcová, H., Cebecauerová, D., Schwarz, J., Karásková, E., Hecht, T., et al. (2023) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjad126 · Cited by 15
Gong, D., Yu, X., Wang, L., Kong, L., Gong, X., & Dong, Q. (2017) · BioMed Research International · doi:10.1155/2017/8102589 · Cited by 15
“However, while EEN has been widely accepted and frequently used as a standard procedure for treating pediatric CD patients [5, 6], the underlying mechanism of EEN-induced remission remains unclear.”
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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