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
Department of Paediatric Gastroenterology, APHP Hôpital Necker Enfants Malades, 149 Rue de Sèvres 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 2 Rue de l'École de Médecine, 75006 Paris, France; INSERM U989, Institut IMAGINE, 24 Bd Montparnasse, 75015 Paris, France.
Department of Paediatrics I, Semmelweis University, Bókay János str. 53, 1083 Budapest, Hungary.
J Crohns Colitis. 2014 Oct;8(10):1179-207. doi: 10.1016/j.crohns.2014.04.005. Epub 2014 Jun 6.
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.
与成年患者相比，患有克罗恩病（CD）的儿童和青少年往往呈现出更复杂的病程。此外，CD对患者生长、青春期和情感发育的潜在影响凸显了对儿童期发病的CD制定特定管理策略的必要性。为了制定首个基于证据且由共识驱动的儿童期发病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、肝病和营养学会公开征集后，成立了一个由33名炎症性肠病专家组成的专家小组。其目的是在对现有证据进行全面审查的基础上，为患有CD的儿童和青少年的药物治疗和长期管理提供最新的指导，并根据不同临床情况进行获益风险分析，制定个体化治疗方案。对于尚未完成生长发育的儿童和青少年，由于其安全性极佳，全肠内营养（EEN）是首选的诱导治疗方法，优于皮质类固醇，后者诱导缓解的效果相当。大多数儿童期发病的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示疾病预后不良的因素（如严重的肛周瘘管病、严重的狭窄/穿透性疾病、严重的生长发育迟缓、全肠炎、尽管诱导治疗充分但疾病仍持续严重），这些因素可能促使采用基于抗TNF的自上而下的治疗方法。这些指南旨在为照顾患有CD的儿童和青少年的（儿科）胃肠病学家提供实用的（尽可能基于证据的）答案；它们并非旨在成为规则或法律标准，因为存在许多不同的临床情况，需要这些指南未涵盖或与之不同的治疗策略。
