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
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
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
For more information, refer to the Summaries of Product Characteristics for the different authorized drugs
Have demonstrated their effectiveness in maintenance treatment9,10
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
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
Gasparetto M, Guariso G. Highlights in IBD Epidemiology and Its Natural History in the Paediatric Age. Gastroenterology Research and Practice. 2013;1-12.
Guide - affection de longue durée. HAS. Maladie de Crohn. Mai 2008.
Guide - affection de longue durée. HAS. Rectocolite hémorragique évolutive. Mai 2008.
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.
Hugot JP. Particularités des maladies inflammatoires chroniques intestinales de l’enfant. mt pédiatrie 2011 ; 14 (3) : 171-9.
Oliveira SB. et al. Diagnosis and management of inflammatory bowel disease in children. BMJ 2017;357:j2083.
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.
Day A. et al. Crohn’s and colitis in children and adolescents. World Journal of Gastroenterology. 2012;18(41):5862-69.
Guariso.G, Gasparetto.M Treating children with inflammatory bowel disease : Current and new perspectives. World J Gastroenterol 2017; 23(30): 5469-5485
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.
ECCO guidelines: Journal of Crohn's and Colitis, 2021, 171–194