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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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Cited by
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Items 401–500 of 999
Nutritional approach as therapeutic manipulation in inflammatory bowel disease
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“IBD patients have significantly lower levels of SCFAs, including butyrate and acetate, than do healthy subjects.81 Butyrate, which is a major type of SCFAs, is an important protective factor against colorectal cancer and might play a protective role against the development of IBD.81,82 Increased SCFA production from f…”
BackgroundInfluentialQuantitative changes in selected bacteria in the stool during the treatment of Crohn's disease
Salamon, D., Gosiewski, T., Krawczyk, A., Sroka-Oleksiak, A., Duplaga, M., Fyderek, K., & Kowalska‐Duplaga, K. (2020) · Advances in Medical Sciences · doi:10.1016/j.advms.2020.06.003 · Cited by 15
“For 6–8 weeks, the patient's diet consists only of standard, liquid, polymeric formulas and is followed by pharmacological treatment with thiopurines or methotrexate (conventional therapy) and mesalazine to maintain remission [8].”
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Ferreira, P. V. D. A. L. S., Cavalcanti, A., & da Silva, G. A. P. (2018) · Jornal de Pediatria · doi:10.1016/j.jped.2018.11.002 · Cited by 15
“…in developing countries, it is worth emphasizing the possibility of another condition that may be overlapping with IBD: environmental enteric dysfunction (environmental enteropathy), which may impair linear growth (stunting) through pathogenic mechanisms that overlap with those described in IBD.”
BackgroundInfliximab for very early‐onset inflammatory bowel disease: A tertiary center experience in Japan
Takeuchi, I., Kaburaki, Y., Arai, K., Shimizu, H., Hirano, Y., Nagata, S., & Shimizu, T. (2019) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.14836 · Cited by 15
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Adler, J., Colletti, R. B., Noonan, L., Berzin, T. M., Cheifetz, A. S., Conklin, L. S., Hoops, T. C., Huang, C. S., Lewis, B. S., Mishkin, D. S., et al. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izac183 · Cited by 14
Kim, E. S., & Kang, B. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i18.2784 · Cited by 14
Timmer, A., Stark, R. G., Peplies, J., Claßen, M., Laass, M. W., & Koletzko, S. (2017) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000956 · Cited by 14
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“It may be that the apparent reduction in disease extent during FU during this 10-year period is due to more aggressive immunosuppression and the increasing use of biological therapies as directed by ESPGHAN/NASPGHAN guidelines (22,23).”
Alhagamhmad, M. H. (2018) · Nutrition in Clinical Practice · doi:10.1002/ncp.10004 · Cited by 14
Choi, S. Y., Choi, Y. O., Choe, Y. H., & Kang, B. (2020) · Journal of Korean Medical Science · doi:10.3346/jkms.2020.35.e114 · Cited by 14
Updates in diagnosis and management of inflammatory bowel disease
Sandberg, K., Yarger, E., & Saeed, S. (2020) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2020.100785 · Cited by 14
Therapeutic strategies for stricturing Crohn’s disease in childhood: a systematic review
Neville, J. J., Macdonald, A. L., Fell, J. M. E., Choudhry, M., & Haddad, M. J. (2021) · Pediatric Surgery International · doi:10.1007/s00383-020-04848-0 · Cited by 14
“Medical therapies are used to induce or maintain remission in paediatric CD [3, 9].”
BackgroundInfluentialMeineri, G., Martello, E., Radice, E., Bruni, N., Saettone, V., Atuahene, D., Armandi, A., Testa, G., & Ribaldone, D. G. (2022) · Animals · doi:10.3390/ani12070812 · Cited by 14
“Exclusive enteral nutrition (EEN) is an exception since it is prescribed as a first-line treatment for children and adolescents with acute active CD to promote remission [36].”
BackgroundClaßen, M., de Laffolie, J., Claßen, M., Schnell, A., Sohrabi, K., & Hoerning, A. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.903677 · Cited by 14
“Significantly more patients fulfilled the criteria for POPO positivity (95.6”
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Basiaga, M. L., Ross, M., Gerber, J. S., & Ogdie, A. (2017) · Journal of the Pediatric Infectious Diseases Society · doi:10.1093/jpids/pix052 · Cited by 15
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Bronský, J., Čopová, I., Kazeka, D., Lerchová, T., Mitrová, K., Pospíšilová, K., Sulovcova, M., Zárubová, K., & Hradský, O. (2022) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000490 · Cited by 13
“DISCUSSION In accordance with guidelines on the management of pediatric CD, the selection of anti-TNF therapy (ADA vs IFX) in anti-TNF naive patients is based on patient and family preference, drug availability, administration route, and cost (10,11).”
Diet as therapeutic intervention in Crohn’s disease
Więcek, M., Panufnik, P., Pomorska, K., Lewandowski, K., & Rydzewska, G. M. (2022) · Gastroenterology Review · doi:10.5114/pg.2022.116376 · Cited by 13
Colorectal Cancer in Childhood‐onset Inflammatory Bowel Disease
Everhov, A. H., Ludvigsson, J. F., Järås, J., Erichsen, R., Pedersen, L. H., Halfvarson, J., Askling, J., Ekbom, A., Sørensen, H. T., & Olén, O. (2022) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003574 · Cited by 13
“No evidence-based guidelines exist for surveillance of CRC in childhood-onset CD (19).”
BackgroundRen, H., Kang, J., Wang, J., Su, J., Zou, L., Yin, A., Li, J., Zhou, Q., Wang, W. J., Tang, Z., et al. (2023) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izad184 · Cited by 13
The Effect of Protein Nutritional Support on Inflammatory Bowel Disease and Its Potential Mechanisms
Li, Q., & Wang, J. (2024) · Nutrients · doi:10.3390/nu16142302 · Cited by 14
“Only in special cases where patients have milk protein allergy, a switch to elemental diets is recommended to ensure the safety and effectiveness of nutritional intake [167].”
BackgroundBouchard, D., Brochard, C., Vinson-Bonnet, B., Staumont, G., Abramowitz, L., Benfredj, P., Fathallah, N., Faucheron, J. ‐., Higuero, T., Panis, Y. H., et al. (2019) · Techniques in Coloproctology · doi:10.1007/s10151-019-01971-6 · Cited by 13
Natural history of children with mild Crohn’s disease
Sharma, Y., Bousvaros, A., Liu, E., & Stern, J. B. (2019) · World Journal of Gastroenterology · doi:10.3748/wjg.v25.i30.4235 · Cited by 13
Assa, A., Avni, I., Ben‐Bassat, O., Niv, Y., & Shamir, R. (2015) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000000943 · Cited by 13
“Co (ECCO)/European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) consensus guidelines (18) recommend on testing TPMT activity before TP initiation when available.”
BackgroundInfluential149 The Indirect Costs and Family Burden of Pediatric Crohn's Disease in the United States
Kahn, S. A., Lin, C.-W., Ozbay, A. B., Chao, J., & Skup, M. (2015) · Gastroenterology · doi:10.1016/s0016-5085(15)30138-4 · Cited by 13
Stippler, D., Bode, V., Fischer, M., Kollex, K., Rohde, E., Tisowsky, B., Künstner, J., & Pahne, N. (2015) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2015.07.003 · Cited by 13
Bamberger, S., Martinez‐Vinson, C., Mohamed, D., Viala, J., Carel, J., Hugot, J., & Simon, D. (2016) · PLoS ONE · doi:10.1371/journal.pone.0163126 · Cited by 13
“Induction and maintenance doses were those recommended in guidelines for anti-TNFα therapy [18]: infliximab, 5mg/kg at weeks 0, 2 and 6 and then 5mg/kg injection every 8 weeks; adalimumab, 160 mg if weight>40kg or 80 mg if weight<40kg at week 0, 80mg if weight>40kg or 40 mg if weight<40kg at week 2 and thereafter a su…”
BackgroundEvaluation of Infliximab Therapy in Children with Crohn's Disease Using Trough Levels Predictors
Ohem, J., Hradský, O., Zárubová, K., Čopová, I., Bukovska, P., Průša, R., Malíčková, K., & Bronský, J. (2017) · Digestive Diseases · doi:10.1159/000477962 · Cited by 13
Medical management of pediatric inflammatory bowel disease
Baldwin, K. R., & Kaplan, J. L. (2017) · Seminars in Pediatric Surgery · doi:10.1053/j.sempedsurg.2017.10.005 · Cited by 13
“MR enterography findings have recently been shown to correlate well with MH defined by ileocolonoscopy in children with CD.70 Ideally, in the future, composite scoring systems that include clinical symptoms, serum and stool biomarkers, and radiographic markers will correlate better with endoscopic findings, decreasing…”
BackgroundInfluentialde Laffolie, J., Laass, M. W., Scholz, D., Zimmer, K., Buderus, S., & CEDATA-GPGE Study Group (2017) · Gastroenterology Research and Practice · doi:10.1155/2017/8424628 · Cited by 13
Predicting and preventing complications in children with inflammatory bowel disease
Grover, Z. (2019) · Translational Pediatrics · doi:10.21037/tp.2019.01.03 · Cited by 13
Ishige, T., Tomomasa, T., Tajiri, H., Yoden, A., & Japanese Study Group for Pediatric Crohn's Disease (2017) · Intestinal Research · doi:10.5217/ir.2017.15.3.345 · Cited by 13
Kim, P. H., Kim, S., Cho, Y. A., Yoon, H. M., Lee, J. S., Jung, A. Y., Oh, S. H., Kim, D. Y., Namgoong, J., & Kim, K. M. (2021) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjab004 · Cited by 12
Serum cytokines MCP-1 and GCS-F as potential biomarkers in pediatric inflammatory bowel disease
Ott, A., Tutdibi, E., Goedicke‐Fritz, S., Schöpe, J., Zemlin, M., & Nourkami‐Tutdibi, N. (2023) · PLoS ONE · doi:10.1371/journal.pone.0288147 · Cited by 13
Zhang, J. L., Vootukuru, N., & Niewiadomski, O. (2024) · BMC Gastroenterology · doi:10.1186/s12876-024-03315-7 · Cited by 12
“Five children undertaking a whole food diet for 8 weeks demonstrated a reduction in disease activity (weighted PCDAI) ( p = 0.005) and FCP, comparable to that found in children with newly diagnosed CD on EEN [37, 38].”
ResultInfluentialDiagnostic and Therapeutic Approach in Paediatric Inflammatory Bowel Diseases
Bronský, J., de Ridder, L., Ruemmele, F. M., Griffiths, A. M., Buderus, S., Hradský, O., & Hauer, A. C. (2019) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002233 · Cited by 12
Efficacy and Safety of Infliximab in Pediatric Crohn Disease: A Systematic Review and Meta-Analysis
Li, S. L., Reynaert, C. J., Su, A. L., & Sawh, S. C. (2019) · The Canadian Journal of Hospital Pharmacy · doi:10.4212/cjhp.v72i3.2903 · Cited by 12
Outcomes of Primary Ileocolic Resection for Pediatric Crohn Disease in the Biologic Era
Spencer, E. A., Jarchin, L., Rolfes, P. S., Khaitov, S., Greenstein, A., & Dubinsky, M. C. (2021) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003241 · Cited by 12
“Surgery is often viewed and positioned in consensus guidelines as the last therapeutic option (8).”
BackgroundComparison of laparoscopic and open ileocecal resection for Crohn’s disease in children
Dotlačil, V., Lerchová, T., Coufal, Š., Kucerova, B., Schwarz, J., Hradský, O., Škába, R., & Rygl, M. (2023) · Pediatric Surgery International · doi:10.1007/s00383-023-05419-9 · Cited by 12
“All patients were diagnosed with CD based on Porto criteria or revised Porto criteria [8, 9] and were treated according to currently valid European Crohn’s and Colitis Organisation/ European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines [10, 11].”
BackgroundMethodGeesala, R., Zhang, K., Lin, Y.-M., Johnson, J. C., Cong, Y., Cohn, S. M., & Shi, X.-Z. P. (2023) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izad158 · Cited by 12
The role of exclusive enteral nutrition in the management of orofacial granulomatosis in children
Mutalib, M., Khaled, B., Elawad, M., & Kiparissi, F. (2016) · World Journal of Pediatrics · doi:10.1007/s12519-016-0045-7 · Cited by 12
How I treat my inflammatory bowel disease-patients with thiopurines?
Meijer, B., Mulder, C. J. J., Bodegraven, A. A. V., & de Boer, N. K. H. (2016) · World Journal of Gastrointestinal Pharmacology and Therapeutics · doi:10.4292/wjgpt.v7.i4.524 · Cited by 12
Regulation of Antimicrobial Pathways by Endogenous Heat Shock Proteins in Gastrointestinal Disorders
Finlayson-Trick, E. C., Connors, J., Stadnyk, A. W., & Limbergen, J. V. (2018) · Gastrointestinal Disorders · doi:10.3390/gidisord1010005 · Cited by 12
“EEN is a liquid formula diet either composed of individual amino acids (elemental) or intact proteins (polymeric) [152].”
BackgroundKim, S. J., Ratchford, T. L., Buchanan, P. M., Patel, D. R., Tao, T. Y., Teckman, J. H., Brown, J. J., & Farmakis, S. G. (2019) · Pediatric Radiology · doi:10.1007/s00247-019-04369-6 · Cited by 12
“Therefore, not identifying penetrating disease in children whose disease is controlled or whose symptoms are improving would not significantly alter the management of these children [22].”
Bashir, N. S., Walters, T. D., Griffiths, A. M., Ito, S., & Ungar, W. J. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izz267 · Cited by 12
Jagt, J. Z., Pothof, C. D., Buiter, H. J. C., Limbergen, J. V., van Wijk, M. P., Benninga, M. A., de Boer, N. K. H., & de Meij, T. G. J. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-06836-3 · Cited by 12
“However, the role of thiopurines has become debatable due to contradictory results on efficacy in adults with Crohn’s disease (CD) on the one hand [7, 8], and safety concerns on the other [1, 2, 9].”
Dolinšek, J., Rižnik, P., Sabath, L., & Mičetić‐Turk, D. (2015) · Wiener klinische Wochenschrift · doi:10.1007/s00508-015-0915-3 · Cited by 12
Minea, H. O., Sîngeap, A.-M., Minea, M., Juncu, S. S., Muzica, C. M., Sfarti, C. V., Gîrleanu, I., Chiriac, S. A., Miftode, D., Stanciu, C., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25158420 · Cited by 11
“Although pretreatment genotyping is recommended in the European Crohn’s and Colitis Organization (ECCO) guidelines, it has been proven that it could not replace the need to monitor the occurrence of possible adverse effects during the administration of certain drugs [80].”
BackgroundAssuring Quality for Non‐hospital–based Biologic Infusions in Pediatric Inflammatory Bowel Disease
Barfield, E., Sockolow, R., Hoffenberg, E. J., Saeed, S. A., Kim, S. S. Y., Siebold, L., Picoraro, J. A., Moses, J., Dykes, D. M. H., Grossman, A. B., et al. (2018) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001890 · Cited by 11
“Proactive care is preferred rather than a reactive approach to care whereby treatment adjustments are made after overt disease exacerbation, often leading to rescue corticosteroid use and potentially worse health outcomes (25).”
Pediatric Inflammatory Bowel Diseases: Should We Be Looking for Kidney Abnormalities?
Lauritzen, D., Andreassen, B. U., Heegaard, N. H. H., Klinge, L. G., Walsted, A., Neland, M., Nielsen, R. G., & Wittenhagen, P. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy166 · Cited by 11
Choi, S. Y., Kang, B., & Choe, Y. H. (2019) · Gut and Liver · doi:10.5009/gnl18129 · Cited by 11
“Recent treatment guidelines published by the European Crohn’s and Colitis Organisation and the European Society for Pediatric Gastroenterology Hepatology and Nutrition recommend that patients with IBD who exhibit poor prognostic factors during health examinations, including delayed growth and the presence of deep ulce…”
BackgroundGuo, D., Yang, J., Ling, F., Tu, L., Li, J., Chen, Y., Zou, K., Zhu, L., & Hou, X. (2020) · Journal of Immunology Research · doi:10.1155/2020/9430763 · Cited by 11
“It has also been used as a fi rst-line therapy for pediatric patients with CD [6] and was shown to induce clinical remission and mucosal healing and improve body composition in patients with CD [7 – 9].”
Nutritional Aspects of Pediatric Gastrointestinal Diseases
Chio, T. D., Sokollik, C., Peroni, D. G., Hart, L., Simonetti, G. D., Righini‐Grunder, F., & Borrelli, O. (2021) · Nutrients · doi:10.3390/nu13062109 · Cited by 11
“EEN consequently has been established as crucial steroidsparing strategy in pediatrics and is recommended as first-line therapy in pediatric luminal CD in international guidelines [9,10].”
BackgroundA literature review on large intestinal hyperelastic constitutive modeling
Bhattarai, A., Kowalczyk, W., & Trần, T. N. (2021) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2021.105445 · Cited by 13
Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study
Sassine, S., Djani, L., Cambron‐Asselin, C., Savoie-Robichaud, M., Lin, Y. F., Qaddouri, M., Zekhnine, S. F., Grzywacz, K., Groleau, V., Dirks, M., et al. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001650 · Cited by 11
“In addition, EEN is the first therapy suggested to treat pediatric patients withCDduring the induction phase by several guidelines (35) but, by the end of the decade in 2019, only 21.”
BackgroundMethodInflammatory Bowel Disease Self-Management
Malloy, C., Rawl, S. M., & Miller, W. R. (2022) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000657 · Cited by 13
“Pediatric and adult IBD practice guidelines endorsed by national and international gastroenterology organizations do not provide specific recommendations for managing interpersonal relationships with IBD (Lamb et al., 2019; Matsuoka et al., 2018; Ruemmele et al., 2014; Rufo et al., 2012).”
Sigurdsson, G. V., Schmidt, S., Mellström, D., Ohlsson, C., Saalman, R., & Lorentzon, M. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izac181 · Cited by 11
Predicting complications in pediatric Crohn's disease patients followed in CEDATA-GPGE registry
Klamt, J., de Laffolie, J., Wirthgen, E., Stricker, S., Däbritz, J., & the CEDATA-GPGE study group (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1043067 · Cited by 11
“Only children and adolescents with a severe phenotype at the time of diagnosis were initially treated with biologics (32).”
BackgroundDuncan, H., Painesi, A., Buchanan, E., McGrogan, P., Gerasimidis, K., Walker, G., Haddock, G., & Russell, R. (2018) · Acta Paediatrica · doi:10.1111/apa.14268 · Cited by 11
“Using enteral nutrition to induce and maintain remission has clear benefits, but the low palatability of feeds means that up to half of patients on EEN require an alternative route of feeding during the primary treatment course (12).”
BackgroundInfluentialKang, Y., Park, S., Kim, S., Kim, S. Y., & Koh, H. (2019) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2019.22.1.72 · Cited by 11
González, E. S., Mateos, B., López-Muñoz, P., Iborra, M., Moret, I., Nos, P., & Beltrán, B. (2019) · Nutrients · doi:10.3390/nu11051062 · Cited by 11
“Although some studies have assessed EEN in adults, most were less conclusive and had multiple confounding factors; thus, this practice is uncommon in adults with CD [55].”
BackgroundPais, I. P., Espinheira, M. C., Trindade, E., & Dias, J. A. (2020) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002704 · Cited by 11
Lev‐Tzion, R., Ben‐Moshe, T., Abitbol, G., Ledder, O., Peleg, S., Millman, P. N., Shaoul, R. R., Kori, M., Assa, A., Cohen, S., et al. (2021) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003073 · Cited by 11
Mattioli, G., Pio, L., Arrigo, S., Prato, A. P., Montobbio, G., Disma, N. M., & Barabino, A. V. (2015) · Digestive and Liver Disease · doi:10.1016/j.dld.2015.05.003 · Cited by 11
Hojsak, I., Mišak, Z., Jadrešin, O., Pavić, A. M., & Kolaček, S. (2015) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365521.2015.1031166 · Cited by 11
“It is therefore put forward as the ultimate treatment goal in the recently published ECCO-ESPGHAN guidelines in pediatric CD [2].”
BackgroundInfluentialGuilcher, K., Fournier, N., Schoepfer, A. M., Schibli, S., Spalinger, J. H., Braegger, C., & Nydegger, A. (2018) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001197 · Cited by 11
Ong, C., Lim, P. T., Logarajah, V., Liwanag, M. J., Ang, B., Cher, Y., Chiou, F. K., & Kader, A. (2018) · BMC Gastroenterology · doi:10.1186/s12876-018-0907-7 · Cited by 11
van Wassenaer, E. A., Meester, V. L., Kindermann, A., Koot, B. G. P., Benninga, M. A., & de Meij, T. G. J. (2019) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-019-02715-z · Cited by 11
Akutko, K., & Iwańczak, B. M. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11206086 · Cited by 10
“Currently, the only way to adequately assess the severity of inflammatory mucosal lesions is by performing gastrointestinal endoscopy [2,4,28,32].”
BackgroundMethodPawłowska, K., Akutko, K., Umławska, W., Śmieszniak, B., Seredyński, R., Stawarski, A., Pytrus, T., & Iwańczak, B. M. (2023) · Scientific Reports · doi:10.1038/s41598-023-48504-8 · Cited by 10
“IBD was diagnosed according to current at the time guidelines (Porto or revised Porto criteria) 19,20 .”
MethodПлоткин, Л. Л., Buchuk, R., Lujan, R., Focht, G., Greenfeld, S., Kariv, R., Weisband, Y. L., Lederman, N., Matz, E., Dotan, I., et al. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18028 · Cited by 10
“…matched cohort (count (%), mean ± SD or median (IQR) are presented as appropriate). associated with adverse health outcomes, especially in paediatrics, 24 and this finding alone is sufficient to recommend favouring EEN over corticosteroids despite the lack of association with reduced surgery rates.”
BackgroundGao, X., Feng, X., Hou, T., Huang, W. C., Ma, Z., & Zhang, D. (2024) · Food Bioscience · doi:10.1016/j.fbio.2024.105431 · Cited by 10
Turner, D., Russell, R. K., Wine, E., de Carpi, J. M., de Ridder, L., Shouval, D. S., Dias, J. A., & Assa, A. (2024) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1002/jpn3.12395 · Cited by 10
Song, Y., Peng, Y., Fan, X., Li, S., Wang, S., Zhang, H., Lin, C., He, C., Qing, Q., Sun, Y., et al. (2025) · Digestive and Liver Disease · doi:10.1016/j.dld.2025.06.014 · Cited by 10
Brooks, A. J., Smith, P. J., & Lindsay, J. O. (2017) · Frontline Gastroenterology · doi:10.1136/flgastro-2016-100747 · Cited by 10
Characteristics of biological therapy in pediatric patients with Crohn’s disease
Tárnok, A., Kiss, Z., Kadenczki, O., & Veres, G. (2019) · Expert Opinion on Biological Therapy · doi:10.1080/14712598.2019.1564034 · Cited by 10
“Exclusive enteral nutrition is as good at least as corticosteroids when inducing remission in luminal disease; therefore, it is recommended as first-line therapy by current guidelines [3].”
BackgroundMethodOutcomes of Pediatric Fistulising Perianal Crohn’s Disease
Akkelle, B. Ş., Şengül, Ö. K., Volkan, B., Tutar, E., Ergelen, R., Yardımcı, S., & Ertem, D. (2021) · The Turkish Journal of Gastroenterology · doi:10.5152/tjg.2021.191034 · Cited by 10
Herman, R. B., Dumnicka, P., Pieczarkowski, S., & Fyderek, K. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235613 · Cited by 10
“The patients with perianal disease were treated according to commonly accepted criteria [5].”
BackgroundDiet in the Pathogenesis and Management of Crohn's Disease
Gu, P., & Feagins, L. A. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2021.12.008 · Cited by 10
Jongsma, M., Vuijk, S. A., Cozijnsen, M. A., van Pieterson, M., Norbruis, O. F., Groeneweg, M., Wolters, V. M., van Wering, H. M., Hojsak, I., Kolho, K., et al. (2022) · European Journal of Pediatrics · doi:10.1007/s00431-022-04496-7 · Cited by 10
“6-TGN levels below < 230 pmol/8 × 108 RBC were considered insufficient [11].”
Glénisson, M., Bonnard, A., Berrebi, D. D., Belarbi, N., Viala, J., & Martinez‐Vinson, C. (2023) · European Journal of Pediatric Surgery · doi:10.1055/a-2048-7407 · Cited by 10
Greef, E. D., Hoffman, I. E. A., Smets, F. N., Biervliet, S. V., Bontems, P., Hauser, B., Paquot, I., Alliet, P. L., Arts, W. F. M., Dewit, O., et al. (2016) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001132 · Cited by 10
“Most physicians will adhere to a relatively rapid step-up therapy: an early and adequate increase and switch in medication for patients with ongoing disease activity who do not respond to the previously instated treatment (11).”
BackgroundMethodTherapeutic role of methotrexate in pediatric Crohn’s disease
Djurić, Z., Šaranac, L., Budić, I., Pavlović, V., & Djordjević, J. (2018) · Bosnian Journal of Basic Medical Sciences · doi:10.17305/bjbms.2018.2792 · Cited by 10
“According to the new European guidelines, MH is the ultimate goal of therapy in CD patients [20].”
BackgroundHojsak, I., Matic, K., Sila, S., Trivić, I., Mišak, Z., & Kolaček, S. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.04.015 · Cited by 10
Sochet, A. A., Son, S., Ryan, K. S., Roddy, M. R., Barrie, E., Wilsey, M. J., McKinley, S. D., & Nakagawa, T. A. (2019) · Journal of Asthma · doi:10.1080/02770903.2019.1614617 · Cited by 10
Prospects of Using Microbiota Correction Methods in the Treatment of Inflammatory Bowel Disease
Akinshina, A. I., Smirnova, D. V., Zagaynova, A. V., Makarov, V. V., & Yudin, S. M. (2019) · Russian Journal of Gastroenterology Hepatology Coloproctology · doi:10.22416/1382-4376-2019-29-2-12-22 · Cited by 9
Chande, N., Costello, S. P., Limketkai, B. N., Parker, C. E., Nguyen, T. M., MacDonald, J. K., & Feagan, B. G. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izz223 · Cited by 10
Recent advances in understanding and managing pediatric inflammatory bowel disease
Gurram, B., & Patel, A. (2019) · F1000Research · doi:10.12688/f1000research.19609.1 · Cited by 10
Do, P., Andersen, J., Patel, A., Semrin, G., Sifuentes-Dominguez, L., Luu, P., & Gurram, B. (2021) · F1000Research · doi:10.12688/f1000research.22673.2 · Cited by 10
Matuszczyk, M., Meglicka, M., Landowski, P., Czkwianianc, E., Sordyl, B., Szymańska, E., & Kierkuś, J. (2021) · Gastroenterology Review · doi:10.5114/pg.2021.111483 · Cited by 10
“Because nutritional treatment promotes MH, restores bone mineral density, and improves growth, it should be preferred over corticosteroids for all children with inflammatory intestinal luminal disease, including colonic involvement [17, 25].”
BackgroundBoros, K. K., Veres, G., Cseprekál, O., Pintér, H. K., Richter, É., Cseh, Á., Dezsőfi‐Gottl, A., Arató, A., Reusz, G., Dohos, D., et al. (2022) · European Journal of Clinical Nutrition · doi:10.1038/s41430-022-01245-9 · Cited by 10
Pediatric inflammatory bowel disease in Greece: 30-years experience of a single center.
Dimakou, K., Pachoula, I., Panayotou, I., Stefanaki, K. S., Orfanou, I., Lagona, E., Roma‐Giannikou, E., & Chouliaras, G. (2015) · PubMed Central · Cited by 10
Hradský, O., Čopová, I., Zárubová, K., Nevoral, J., & Bronský, J. (2016) · Digestive Diseases and Sciences · doi:10.1007/s10620-016-4103-8 · Cited by 10
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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