Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Viale Regina Elena 324, Rome 00161, Italy.
Department of Radiobiology and Human Health, ENEA (National Agency for Energy, New Technologies and Environment), Via Anguillarese 301, Rome 00123, Italy.
Nat Rev Gastroenterol Hepatol. 2014 Feb;11(2):99-108. doi: 10.1038/nrgastro.2013.158. Epub 2013 Aug 20.
IBD includes two classic entities, Crohn's disease and ulcerative colitis, and a third undetermined form (IBD-U), characterized by a chronic relapsing course resulting in a high rate of morbidity and impaired quality of life. Children with IBD are vulnerable in terms of growth failure, malnutrition and emotional effects. The aims of therapy have now transitioned from symptomatic control to the achievement of mucosal healing and deep remission. This type of therapy has been made possible by the advent of disease-modifying drugs, such as biologic agents, which are capable of interrupting the inflammatory cascade underlying IBD. Biologic agents are generally administered in patients who are refractory to conventional therapies. However, there is growing support that such agents could be used in the initial phases of the disease, typically in paediatric patients, to interrupt and cease the inflammatory process. Until several years ago, most therapeutic programmes in paediatric patients with IBD were borrowed from adult trials, whereas paediatric studies were often retrospective and uncontrolled. However, guidelines on therapeutic management of paediatric IBD and controlled, prospective, randomized trials including children with IBD have now been published. Here, the current knowledge concerning treatment options for children with IBD are reported. We also highlight the effectiveness and safety of new therapeutic advances in these paediatric patients.
IBD 包括两种经典实体，克罗恩病和溃疡性结肠炎，以及第三种未确定形式（IBD-U），其特征为慢性复发性病程，导致发病率高和生活质量受损。IBD 患儿在生长发育不良、营养不良和情绪影响方面处于脆弱状态。治疗的目标现在已经从症状控制转变为实现黏膜愈合和深度缓解。这种治疗类型得益于疾病修饰药物的出现，例如生物制剂，这些药物能够阻断 IBD 潜在的炎症级联反应。生物制剂通常在对常规治疗无效的患者中使用。然而，越来越多的证据表明，这些药物可以在疾病的初始阶段，通常是儿科患者中使用，以中断和停止炎症过程。直到几年前，大多数 IBD 儿科患者的治疗方案都是从成人试验中借鉴而来，而儿科研究往往是回顾性和非对照性的。然而，现在已经发布了关于儿科 IBD 治疗管理的指南以及包括 IBD 患儿的对照、前瞻性、随机试验。在这里，报告了目前关于 IBD 患儿治疗选择的知识。我们还强调了这些儿科患者中新治疗进展的有效性和安全性。
