title: Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease.
abstract: 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.
authors.affiliation: 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. Electronic address: frank.ruemmele@nck.aphp.fr.
authors.forename: F M
authors.initials: FM
authors.lastname: Ruemmele
authors.affiliation: Department of Paediatrics I, Semmelweis University, Bókay János str. 53, 1083 Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Veres
authors.affiliation: Department of Gastroenterology, Helsinki University Hospital for Children and Adolescents, Stenbäckinkatu 11, P.O. Box 281, 00290 Helsinki, Finland.
authors.forename: K L
authors.initials: KL
authors.lastname: Kolho
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, M5G 1X8 Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Griffiths
authors.affiliation: Paediatric Gastroenterology and Nutrition Unit, Tel Aviv University, Edith Wolfson Medical Center, 62 HaLohamim Street, 58100 Holon, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Levine
authors.affiliation: Department of Paediatric Gastroenterology, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Escher
authors.affiliation: Unit of Paediatric Gastroenterology, Hospital S. João, A Hernani Monteiro, 4202-451, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Amil Dias
authors.affiliation: Gastroenterology and Endoscopy Unit, Istituto G. Gaslini, Via G. Gaslini 5, 16148 Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Barabino
authors.affiliation: Division of Gastroenterology and Nutrition, and Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
authors.forename: C P
authors.initials: CP
authors.lastname: Braegger
authors.affiliation: Department of Pediatrics, University Hospital Motol, Uvalu 84, 150 06 Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Bronsky
authors.affiliation: Department of Paediatrics, St. Marien Hospital, Robert-Koch-Str.1, 53115 Bonn, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Buderus
authors.affiliation: Department of Paediatric Gastroenterolgoy, Hepatology and Nutrition, Hospital Sant Joan de Déu, Paseo Sant Joan de Déu 2, 08950 Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martín-de-Carpi
authors.affiliation: Department of Paediatric Gastroenterology, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: De Ridder
authors.affiliation: Department of Pediatrics, Centre for Clinical Research, Entrance 29, Västmanland Hospital, 72189 Västerås/Karolinska Institutet, Stockholm, Sweden.
authors.forename: U L
authors.initials: UL
authors.lastname: Fagerberg
authors.affiliation: Department of Gastroenterology and Nutrition, Hopital Robert Debré, 48 Bd Sérurier, APHP, 75019 Paris, France; Université Paris-Diderot Sorbonne Paris-Cité, 75018 Paris France.
authors.forename: J P
authors.initials: JP
authors.lastname: Hugot
authors.affiliation: Department of Gastroenterology, Hepatology and Feeding Disorders, Instytut Pomnik Centrum Zdrowia Dziecka, Ul. Dzieci Polskich 20, 04-730 Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Kierkus
authors.affiliation: Department of Paediatric Gastroenterology, Children's Hospital, University of Zagreb Medical School, Klaićeva 16, 10000 Zagreb, Croatia.
authors.forename: S
authors.initials: S
authors.lastname: Kolacek
authors.affiliation: Department of Paediatric Gastroenterology, Dr. von Hauner Children's Hospital, Lindwurmstr. 4, 80337 Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Koletzko
authors.affiliation: Department of Gastroenterology and Nutrition, Meyer Children's Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Lionetti
authors.affiliation: Department of Translational Medical Science, Section of Paediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131 Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Miele
authors.affiliation: Paediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Avda. Arroyo de los Ángeles s/n, 29009 Málaga, Spain.
authors.forename: V M
authors.initials: VM
authors.lastname: Navas López
authors.affiliation: Department of Paediatrics 460, Hvidovre University Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Paerregaard
authors.affiliation: Department of Paediatric Gastroenterology, Yorkhill Hospital, Dalnair Street, Glasgow G3 8SJ, United Kingdom.
authors.forename: R K
authors.initials: RK
authors.lastname: Russell
authors.affiliation: 2nd Department of Paediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Emergency Children's Hospital, Crisan nr. 5, 400177 Cluj-Napoca, Romania.
authors.forename: D E
authors.initials: DE
authors.lastname: Serban
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Rambam Health Care Campus Rappaport Faculty Of Medicine, 6 Ha'alya Street, P.O. Box 9602, 31096 Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Shaoul
authors.affiliation: Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Van Rheenen
authors.affiliation: Department of Paediatric Gastroenterology and Nutrition, Children's University Hospital, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Veereman
authors.affiliation: Paediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52625 Tel Hashomer, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Weiss
authors.affiliation: Child Life and Health, Paediatric Gastroenterology, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Department of Medicine I, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431 Frankfurt/Main, Gemany.
authors.forename: A
authors.initials: A
authors.lastname: Dignass
authors.affiliation: 33-Gastroenterology, Sheba Medical Center, 52621 Tel Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Eliakim
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mass General Hospital for Children, 175 Cambridge Street, 02114 Boston, United States.
authors.forename: H
authors.initials: H
authors.lastname: Winter
authors.affiliation: Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Turner
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000465:Algorithms; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D004750:Enteral Nutrition; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D060046:Maintenance Chemotherapy / Q000379:methods*; D015122:Mercaptopurine / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D012074:Remission Induction / Q000379:methods*; D013792:Thalidomide / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000305:Adrenal Cortex Hormones; D000636:Aminosalicylic Acids; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D013792:Thalidomide; D000069285:Infliximab; D015122:Mercaptopurine; D000068879:Adalimumab; D001379:Azathioprine; D008727:Methotrexate
keywords: Crohn's disease; Guidelines; Medical therapy; Pediatric