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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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Oshlyanska, O. A., Березенко, В. С., Nadtochiy, T. G., Doroshenko, A. O., Artzymovich, A. G., & Крат, В. В. (2019) · PERINATOLOGIYA I PEDIATRIYA · doi:10.15574/pp.2019.77.85 · Cited by 1
Modráčková, N., Bunešová, V., Vlková, E., Musilová, Š., Mrvikova, I., Bronský, J., Čopová, I., Hradský, O., & Nevoral, J. (2019) · Journal of Medicinal Food · doi:10.1089/jmf.2019.0021 · Cited by 1
“1,7,12 Furthermore, it can be used to treat relapse, 13 and is closely associated with changes to the patient microbiota and the suppression of intestinal dysbiosis.”
Crohn's disease in a girl with VACTERL association: Can mitochondrial dysfunction coexist?
Peña-Vélez, R., Almanza-Miranda, E., & Zaragoza-Arévalo, G. R. (2019) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastre.2018.10.003 · Cited by 1
Safety of anti-TNF biologics in paediatric inflammatory bowel disease
Ruemmele, F. M. (2019) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(19)30292-4 · Cited by 1
To the question of the differential diagnosis of fever of unknown origin in children: a special case
Oshlyanska, O. A., Muzyka, N. M., Archakova, T. М., Nadtochiy, T. G., & Doroshenko, A. O. (2019) · Ukrainian journal of Perinatology and Pediatrics · doi:10.15574/pp.2019.79.49 · Cited by 1
Harmonizing Nutritional Therapies for Pediatric Inflammatory Bowel Disease
Picoraro, J. A., Akabas, S., & LeLeiko, N. S. (2019) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002602 · Cited by 1
“With a favorable side effect profile, EEN is a first-line therapy for pediatric patients with CD under guidelines endorsed by the European Society of Pediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organization (11).”
BackgroundMartin, N. G., Roberts, A. J., Evans, H., Bishop, J., & Day, A. S. (2020) · JGH Open · doi:10.1002/jgh3.12310 · Cited by 1
Pérez, A. I. P., Muncunill, G. P., Sánchez, P. D., Feo‐Ortega, S., & de Carpi, J. M. (2020) · Anales de Pediatría · doi:10.1016/j.anpedi.2020.03.017 · Cited by 1
Ha, C., Kim, E. S., Kwon, Y., Choe, Y. H., Kim, M. J., & Lee, S. (2020) · Pharmacogenomics and Personalized Medicine · doi:10.2147/pgpm.s279446 · Cited by 1
Pérez, A. I. P., Muncunill, G. P., Sánchez, P. D., Feo‐Ortega, S., & de Carpi, J. M. (2021) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2020.03.017 · Cited by 1
Unique Challenges in the Diagnosis and Management of the Pediatric IBD Patient
Morganstern, J. A., & Schosheim, A. (2021) · Clinical gastroenterology · doi:10.1007/978-3-030-81780-0_9 · Cited by 1
A whole-food exclusion diet as monotherapy for Crohn's disease
Sasson, A. N. (2021) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(21)00335-6 · Cited by 1
Clinical Indices for Pediatric Inflammatory Bowel Disease Research
Turner, D., & Ledder, O. (2017) · Springer eBooks · doi:10.1007/978-3-319-49215-5_46 · Cited by 1
Perianal disease as the first manifestation in paediatric Crohn's disease
Solís, A. M. S., Antuña, L. F., Cuadra, Y. R., & Castellarnau, E. (2020) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastre.2019.11.011 · Cited by 1
Choi, Y. M., Kim, J. M., Moon, J. S., Ko, J. S., & Yang, H. R. (2023) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003731 · Cited by 1
“MTX administration has been recommended as either primary maintenance or after TP therapy failure in pediatric CD patients (2).”
BackgroundBashir, N. S. (2019) · TSpace (University of Toronto) · Cited by 1
Healey, G. R., Tsai, K., Lisko, D. J., Cook, L. E., Vallance, B. A., & Jacobson, K. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.02.02.429403 · Cited by 1
Diet‐Based Microbiome Modulation: You are What You Eat
Li, J., Qu, Z., Liu, F., Hao, J., Pan, Y., Guo, S., & Ho, C. L. (2022) · Wiley eBooks · doi:10.1002/9783527825462.ch1 · Cited by 1
The Microbiome, diet and health
OECD (2017) · OECD science, technology and industry policy papers · doi:10.1787/d496f56d-en · Cited by 1
The Prevention and Treatment of Neuropathic and Visceral Pain
Baerg, K., & Mesaroli, G. (2024) · doi:10.1002/9781119645641.ch8 · Cited by 1
Diagnosing and Managing Inflammatory Bowel Disease in Young Children
Alkureishi, L. A., Hageman, J. R., & Biank, V. (2024) · Pediatric Annals · doi:10.3928/19382359-20241022-01 · Cited by 1
Zheng, H. B., Doran, B. A., Kimler, K., Yu, A., Tkachev, V., Niederlová, V., Cribbin, K., Fleming, R., Bratrude, B., Betz, K., et al. (2025) · eLife · doi:10.7554/elife.91792.2 · Cited by 1
Nutritional Management of Inflammatory Bowel Disease
Otley, A. R., Day, A. S., & Zachos, M. (2012) · Springer eBooks · doi:10.1007/978-1-4614-5061-0_28
Parzęcka, M., Szaflarska‐Popławska, A., Nowicka, M., & Kowalczyk, A. (2015) · Pediatria Polska · doi:10.1016/j.pepo.2015.01.007
The ‘Ideal' Anti-TNF Patient: Indications for Anti-TNF Therapy in Crohn's Disease
Tran‐Minh, M., Baudry, C., & Allez, M. (2015) · Frontiers of gastrointestinal research · doi:10.1159/000381597
Maladie de Crohn chez l’enfant : place de la prise en charge nutritionnelle
Hubert, G., Willot, S., & Caldari, D. (2015) · Nutrition Clinique et Métabolisme · doi:10.1016/j.nupar.2015.09.007
Stephens, M., & Mavis, A. (2012) · Springer eBooks · doi:10.1007/978-1-4614-5061-0_26
Morbus Crohn und Colitis ulcerosa bei Kindern und Jugendlichen
Keller, K. (2015) · Springer eBooks · doi:10.1007/978-3-642-54671-6_154-1
Indications et techniques de la vidéocapsule endoscopique de l’intestin grêle chez l’enfant
Lachaux, A. (2016) · Acta Endoscopica · doi:10.1007/s10190-016-0529-2
“Pour analyser au mieux l’intestin grêle, il a été récemment recommandé d’utiliser la VCE chez l’enfant [37].”
Jarzębicka, D., Sieczkowska, J., Oracz, G., & Kierkuś, J. (2015) · Postępy Nauk Medycznych · doi:10.5604/08606196.1190918
“The indications for the therapy with anti-TNF are active, severe inflammation of the intestines and/or perianal lesions with the ineffectiveness of the drugs with less potency (1, 3-8).”
BackgroundQuand débuter une nutrition entérale?
Dubern, B. (2015) · Archives de Pédiatrie · doi:10.1016/s0929-693x(15)30031-2
Probiotics and Crohn’s Disease
Kroeker, K. I., & Lu, C. (2016) · InTech eBooks · doi:10.5772/64870
“In the recent ECCO/ESPGHAN guidelines, exclusive enteral nutrition is recommended as first-line therapy to induce remission in children with active luminal CD [7].”
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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