Lev-Tzion R, Turner D
Division of Pediatric Gastroenterology and Nutrition, Washington University, St. Louis, MS, USA.
Minerva Gastroenterol Dietol. 2012 Jun;58(2):137-50.
The incidence of pediatric inflammatory bowel disease (IBD) continues to rise in most countries. Approximately 20-25% of IBD patients present before the age of 20, and their management is associated with many unique challenges. These challenges stem both from the inherent differences between children and adults, and from the differences in the nature and course of the disease. Children with IBD are more likely than adults to present with extensive disease ‑ both in Crohn's disease (CD) and ulcerative colitis (UC). Diagnosis requires a high index of suspicion, as children may present with less typical signs such as poor growth and delayed puberty. In the very young patients with inflammatory bowel disease, the pediatric clinician must consider a broader range of immunological and allergic disorders. Optimal management requires recognition of pediatric patterns of presentation, efficacy and adverse-effect profiles, and understanding monitoring aspects unique to pediatrics. These aspects include pediatric disease-related psychological issues, adherence to therapy and transition to adult care. Inadequate attention to growth, puberty or bone health in childhood can result in long-term consequences, such as impaired adult height and increased risk of fractures. Management of pediatric IBD and prevention of adverse long-term consequences relies on a variety of therapies well-known to the adult practitioner, along with therapies that are not widespread in adults, most notably exclusive enteral nutrition (EEN). The latter is as effective as corticosteroids in achieving clinical remission in children, while achieving better results than corticosteroids with regard to mucosal healing and growth. This review discusses the broad variety of issues that form the basis for management of pediatric IBD.
在大多数国家，儿童炎症性肠病（IBD）的发病率持续上升。约20%-25%的IBD患者在20岁之前发病，对他们的治疗面临许多独特挑战。这些挑战既源于儿童与成人之间的固有差异，也源于疾病性质和病程的差异。IBD患儿比成人更易出现广泛性疾病，无论是克罗恩病（CD）还是溃疡性结肠炎（UC）。由于儿童可能表现出不太典型的症状，如生长发育迟缓、青春期延迟，因此诊断需要高度的怀疑指数。对于非常年幼的炎症性肠病患者，儿科临床医生必须考虑更广泛的免疫和过敏性疾病。最佳治疗需要认识到儿科的表现模式、疗效和不良反应特征，并了解儿科特有的监测方面。这些方面包括儿科疾病相关的心理问题、治疗依从性以及向成人护理的过渡。儿童期对生长、青春期或骨骼健康关注不足可能导致长期后果，如成人身高受损和骨折风险增加。儿童IBD的治疗及预防长期不良后果依赖于成人从业者熟知的多种疗法，以及在成人中未广泛应用的疗法，最显著的是全肠内营养（EEN）。后者在使儿童实现临床缓解方面与皮质类固醇一样有效，而在黏膜愈合和生长方面比皮质类固醇效果更好。本综述讨论了构成儿童IBD治疗基础的广泛问题。
