Crohn's disease in pediatrics:

Chronic inflammatory diseases of the intestine around the world among the general population1

The causes are being debated, still poorly identified, including2,3,4:

  • Genetic predisposition
  • Immunological factors
  • Environmental factors (hygiene, antibiotic therapy in childhood, appendectomy, etc.)

Who is affected?

Mainly young adults will be affected as illustrated in the below figure:5

Pediatric Crohn's disease is affecting an increasing number of children and adolescents.4

Diagnosis

Most frequent symptoms7:

Top 3 Most common symptoms

Other frequent symptoms

Abdominal pain

Chronic diarrhea

Weight loss

Growth retardation (circulating pro-inflammatory cytokines, anorexia, malabsorption, digestive losses, etc.)5

Anaemia

Fever

Possible extra-digestive manifestations

Diagnostic tools7,8:

  Imaging

Endoscopy: a key step in diagnosis, performed under general anesthesia

Radiology: entero-MRI

  Biology
  (markers of inflammation)

Serum markers. E.g. increased CRP, erythrocyte sedimentation rate, blood count, albuminemia

Fecal markers. E.g. calprotectin

  Anatomopathology

Histology. Multiple biopsies of all segments

The lesions are generally more extensive, and the disease is considered more progressive in children than in adults.5

 

Why treat? 2,8-10

Treatment is necessary for three main reasons:

  1. To act on the disease

To induce and maintain remission
To prevent relapses
To detect and treat early the complications of the natural history of the disease

  2. To maintain a social life

To improve quality of life8

  3. To preserve growth

To allow satisfactory growth2
To ensure the maintenance of a nutritionally correct condition2
To ensure pubertal development10

 

How to treat?9-11

Main treatment options

Main characteristics


INDUCTION

For more information, refer to the Summaries of Product Characteristics for the different authorised drugs

   Exclusive enteral nutrition

Generally used in first-line treatment of flare-ups10
Has demonstrated its ability to induce a remission9,10
Clinical remission rate of approximately 80%, an efficacy comparable to that of corticosteroid therapy9,10
Also allows an improvement in nutritional status9

    Corticosteroid therapy

To be avoided, where possible, because of the potential repercussions on growth10
Can be used if exclusive enteral nutrition is not practicable for inducing a remission in moderate to severe Crohn’s disease10
Clinical remission rate of approximately 80%9
Not suitable for maintenance purposes9,10

MAINTENANCE

For more information, refer to the Summaries of Product Characteristics for the different authorized drugs

   Thiopurines Have demonstrated their effectiveness in maintenance treatment9,10
   Anti-TNFα

Used in second-line treatment for moderate to severe pediatric Crohn’s disease10

ECCO 2021 Ped CD Anti-TNF as induction can be used in following case: In new-onset patients with high risk for a complicated disease course, anti-TNF therapy is recommended forinducing remission.11

    Methotrexate Can be used to maintain clinical remission as a first-choice immunomodulator, or after thiopurine failure or intolerance.11

Surgical indications are restricted to severe conditions and/or cases where drug treatments have failed.5

  1. Gasparetto M, Guariso G. Highlights in IBD Epidemiology and Its Natural History in the Paediatric Age. Gastroenterology Research and Practice. 2013;1-12.
  2. Guide - affection de longue durée. HAS. Maladie de Crohn. Mai 2008.
  3. Guide - affection de longue durée. HAS. Rectocolite hémorragique évolutive. Mai 2008.
  4. Barnes EL. et al. Increasing Incidence of Pediatric Inflammatory Bowel Disease in France: Implications for Etiology, Diagnosis, Prognosis, and Treatment. Am J Gastroenterol 2018; 113:273–275.
  5. Hugot JP. Particularités des maladies inflammatoires chroniques intestinales de l’enfant. mt pédiatrie 2011 ; 14 (3) : 171-9.
  6. Oliveira SB. et al. Diagnosis and management of inflammatory bowel disease in children. BMJ 2017;357:j2083.
  7. Levine A, Koletzko S, Turner D, Escher J, Cucchiara S. ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents. Journal of Pediatric Gastroenterology and Nutrition. 2014;58(6):795-806.
  8. Day A. et al. Crohn’s and colitis in children and adolescents. World Journal of Gastroenterology. 2012;18(41):5862-69.
  9. Guariso.G, Gasparetto.M Treating children with inflammatory bowel disease : Current and new perspectives. World J Gastroenterol 2017; 23(30): 5469-5485
  10. Ruemmele F. et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. Journal of Crohn’s and Colitis. 2014;8(10):1179-1207.
  11. ECCO guidelines: Journal of Crohn's and Colitis, 2021, 171–194

CD: Crohn's disease
CRP: C-reactive protein;
MRI: Magnetic Resonance Imaging; 
TNF: Tumor Necrosis Factor


AbbVie SA/NV - BE-IMM-210057 (v1.0) - July 2021