Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

被引：810

作者：

Ruemmele, F. M. ^{[1
,2
,3
]}

Veres, G. ^{[4
]}

Kolho, K. L. ^{[5
]}

Griffiths, A. ^{[6
]}

Levine, A. ^{[7
]}

Escher, J. C. ^{[8
]}

Dias, J. Amil ^{[9
]}

Barabino, A. ^{[10
]}

Braegger, C. P. ^{[11
,12
]}

Bronsky, J. ^{[13
]}

Buderus, S. ^{[14
]}

Martin-de-Carpi, J. ^{[15
]}

De Ridder, L. ^{[16
]}

Fagerberg, U. L. ^{[17
]}

Hugot, J. P. ^{[18
,19
]}

Kierkus, J. ^{[20
]}

Kolacek, S. ^{[21
]}

Koletzkou, S. ^{[22
]}

Lionetti, P. ^{[23
]}

Miele, E. ^{[24
]}

Navas Lopez, V. M. ^{[25
]}

Paerregaard, A. ^{[26
]}

Russell, R. K. ^{[27
]}

Serban, D. E. ^{[28
]}

Shaoul, R. ^{[29
]}

Van Rheenen, P. ^{[30
]}

Veereman, G. ^{[31
]}

Weiss, B. ^{[32
]}

Wilson, D. ^{[33
]}

Dignass, A. ^{[34
]}

Eliakim, A. ^{[35
]}

Winter, H. ^{[36
]}

Turner, D. ^{[37
]}

机构：

[1] Hop Necker Enfants Malad, AP HP, Dept Paediat Gastroenterol, F-75015 Paris, France

[2] Univ Paris 05, Sorbonne Paris Cite, F-75006 Paris, France

[3] INSERM, U989, Inst IMAGINE, F-75015 Paris, France

[4] Semmelweis Univ, Dept Paediat 1, H-1083 Budapest, Hungary

[5] Univ Helsinki, Dept Gastroenterol, Hosp Children & Adolescents, FIN-00290 Helsinki, Finland

[6] Univ Toronto, Hosp Sick Children, Dept Paediat, Toronto, ON M5G 1X8, Canada

[7] Tel Aviv Univ, Paediat Gastroenterol & Nutr Unit, Edith Wolfson Med Ctr, IL-58100 Holon, Israel

[8] Erasmus MC, Dept Paediat Gastroenterol, NL-3015 CN Rotterdam, Netherlands

[9] Hosp Sao Joao, Unit Paediat Gastroenterol, P-4202451 Oporto, Portugal

[10] Ist Giannina Gaslini, Gastroenterol & Endoscopy Unit, I-16148 Genoa, Italy

[11] Univ Childrens Hosp Zurich, Div Gastroenterol & Nutr, CH-8032 Zurich, Switzerland

[12] Univ Childrens Hosp Zurich, Childrens Res Ctr, CH-8032 Zurich, Switzerland

[13] Univ Hosp Motol, Dept Pediat, Prague 15006, Czech Republic

[14] St Marien Hosp, Dept Paediat, D-53115 Bonn, Germany

[15] Hosp St Joan de Deu, Dept Paediat Gastroenterolgoy Hepatol & Nutr, Barcelona 08950, Spain

[16] Erasmus MC, Dept Paediat Gastroenterol, NL-3015 CN Rotterdam, Netherlands

[17] Karolinska Inst, Vastmanland Hosp, Clin Res Ctr, Dept Pediat, S-72189 Stockholm, Sweden

[18] Hop Robert Debre, AP HP, Dept Gastroenterol & Nutr, F-75019 Paris, France

[19] Univ Paris Diderot, Sorbonne Paris Cite, F-75018 Paris, France

[20] Inst Pomn Ctr Zdrowia Dziecka, Dept Gastroenterol Hepatol & Feeding Disorders, PL-04730 Warsaw, Poland

[21] Univ Zagreb, Sch Med, Childrens Hosp, Dept Paediat Gastroenterol, Zagreb 10000, Croatia

[22] Dr von Hauner Childrens Hosp, Dept Paediat Gastroenterol, D-80337 Munich, Germany

[23] Meyer Childrens Hosp, Dept Gastroenterol & Nutr, I-50139 Florence, Italy

[24] Univ Naples Federico II, Paediat Sect, Dept Translat Med Sci, I-80131 Naples, Italy

[25] Hosp Materno Infantil, Paediat Gastroenterol & Nutr Unit, Malaga 29009, Spain

[26] Hvidovre Univ Hosp, Dept Paediat 460, DK-2650 Hvidovre, Denmark

[27] Yorkhill Hosp, Dept Paediat Gastroenterol, Glasgow G3 8SJ, Lanark, Scotland

[28] Iuliu Hatieganu Univ Med & Pharm, Emergency Childrens Hosp, Dept Paediat 2, Cluj Napoca 400177, Romania

[29] Rambam Hlth Care Campus, Rappaport Fac Med, Dept Pediat Gastroenterol & Nutr, IL-31096 Haifa, Israel

[30] Univ Groningen, Univ Med Ctr Groningen, Dept Paediat Gastroenterol Hepatol & Nutr, NL-9700 RB Groningen, Netherlands

[31] Childrens Univ Hosp, Dept Paediat Gastroenterol & Nutr, B-1090 Brussels, Belgium

[32] Edmond & Lily Safra Childrens Hosp, Sheba Med Ctr, Paediat Gastroenterol & Nutr Unit, Tel Hashomer, Israel

[33] Royal Hosp Sick Children, Child Life & Hlth, Edinburgh EH9 1LF, Midlothian, Scotland

[34] Mass Gen Hosp Children, Div Pediat Gastroenterol Hepatol & Nutr, Boston, MA 02114 USA

[35] Hebrew Univ Jerusalem, Pediat Gastroenterol Unit, Shaare Zedek Med Ctr, IL-91905 Jerusalem, Israel

[36] Agaplesion Markus Hosp, Dept Med 1, D-60431 Frankfurt, Germany

[37] Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel

来源：

JOURNAL OF CROHNS & COLITIS | 2014年 / 8卷 / 10期

基金：

英国医学研究理事会;

关键词：

Pediatric; Crohn's disease; Guidelines; Medical therapy; INFLAMMATORY-BOWEL-DISEASE; TERM-FOLLOW-UP; EXCLUSIVE ENTERAL NUTRITION; RANDOMIZED CONTROLLED-TRIAL; NONMELANOMA SKIN CANCERS; NEWLY-DIAGNOSED CHILDREN; SINGLE-CENTER EXPERIENCE; T-CELL LYMPHOMA; QUALITY-OF-LIFE; INFLIXIMAB THERAPY;

D O I：

10.1016/j.crohns.2014.04.005

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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. (C) 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

引用

页码：1179 / 1207

页数：29

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