Systematic review of the evidence base for the medical treatment of paediatric inflammatory bowel disease.
OBJECTIVE
To systematically review the evidence base for the medical (pharmaceutical and nutritional) treatment of paediatric inflammatory bowel disease.


METHODS
Key clinical questions were formulated regarding different treatment modalities used in the treatment of paediatric (not adult-onset) IBD, in particular the induction and maintenance of remission in Crohn disease and ulcerative colitis. Electronic searches were performed from January 1966 to December 2006, using the electronic search strategy of the Cochrane IBD group. Details of papers were entered on a dedicated database, reviewed in abstract form, and disseminated in full for appraisal. Clinical guidelines were appraised using the AGREE instrument and all other relevant papers were appraised using Scottish Intercollegiate Guidelines Network methodology, with evidence levels given to all papers.


RESULTS
A total of 6285 papers were identified, of which 1255 involved children; these were entered on the database. After critical appraisal, only 103 publications met our criteria as evidence on medical treatment of paediatric IBD. We identified 3 clinical guidelines, 1 systematic review, and 16 randomised controlled trials; all were of variable quality, with none getting the highest methodological scores.


CONCLUSIONS
This is the first comprehensive review of the evidence base for the treatment of paediatric IBD, highlighting the paucity of trials of high methodological quality. As a result, the development of clinical guidelines for managing children and young people with IBD must be consensus based, informed by the best-available evidence from the paediatric literature and high-quality data from the adult IBD literature, together with the clinical expertise and multidisciplinary experience of paediatric IBD experts.
Wilson
D C
DC
Child Life and Health, University of Edinburgh, and the Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK.
Thomas
A G
AG
Croft
N M
NM
Newby
E
E
Akobeng
A K
AK
Sawczenko
A
A
Fell
J M E
JM
Murphy
M S
MS
Beattie
R M
RM
Sandhu
B K
BK
Mitton
S G
SG
Casson
D
D
Elawad
M
M
Heuschkel
R
R
Jenkins
H
H
Johnson
T
T
Macdonald
S
S
Murch
S H
SH
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D001842:Bone and Bones / Q000187:drug effects; D002648:Child; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000178:diet therapy / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D019804:Mesalamine / Q000627:therapeutic use; D012074:Remission Induction; D012460:Sulfasalazine / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007155:Immunologic Factors; D012460:Sulfasalazine; D019804:Mesalamine