Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease
Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease
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DOI：
10.1016/j.crohns.2014.04.005
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发表时间：
2014-10-01
影响因子：
8
通讯作者：
Turner, D.
中科院分区：
文献类型：
--
作者：
Ruemmele, F. M.;Veres, G.;Turner, D.
与成人患者相比，儿童和青少年克罗恩病（CD）通常表现出更复杂的病程。此外，CD对患者的生长、青春期和情感发育的潜在影响强调了对儿科发病CD的特定管理策略的必要性。为了制定首个基于证据和共识的儿童发病CD指南，在欧洲克罗恩病和结肠炎组织以及欧洲儿科胃肠病、肝病学和营养学会的公开呼吁后，成立了一个由33名IBD专家组成的专家小组。目的是基于对现有证据的全面审查，根据不同的临床情况，采用基于获益-风险分析的个体化治疗算法，为CD儿童和青少年的药物治疗和长期管理提供最新技术水平指南。在未完成生长的儿童和青少年中，单纯肠内营养（EEN）是诱导治疗的首选，因为其具有良好的安全性，优于皮质类固醇，后者具有诱导缓解的潜力。大多数儿童期CD患者需要基于免疫调节剂的维持治疗。专家们讨论了几个可能预测不良疾病结局的因素（如重度肛周瘘管病、重度狭窄/穿透性疾病、重度生长迟缓、全肠疾病、尽管进行了充分的诱导治疗但仍持续存在重度疾病），这些因素可能会促使采用基于抗TNF的自上而下的方法。这些指南旨在为治疗CD儿童和青少年的（儿科）胃肠病学家提供实用（尽可能以证据为基础）的答案;它们并不意味着成为规则或法律的标准，因为存在许多不同的临床情况，需要这些指南未涵盖或不同于这些指南的治疗策略。(C)2014年欧洲克罗恩病和结肠炎组织。Elsevier B. V.出版，保留所有权利。
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.