Managing complicated Crohn's disease in children and adolescents
Matjaz Homan1, Robert N Baldassano, Petar Mamula
1University Pediatric Hospital, Ljubljana, Slovenia.
Insights
Pediatric Crohn's disease management focuses on remission, growth, and quality of life, especially for those resistant to standard treatments. Biologic therapies like infliximab offer new hope but require further safety evaluation.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Therapeutics
Background:
- Crohn's disease (CD) in children presents unique challenges, including recurrent exacerbations and resistance to conventional therapies.
- Therapeutic goals in pediatric CD extend beyond remission to include optimal growth, development, and quality of life within a critical developmental window.
- Standard treatments include 5-aminosalicylic acid compounds, antibiotics, and enteral nutrition, with immunomodulators for refractory cases.
Purpose of the Study:
- To review the therapeutic landscape for pediatric Crohn's disease, emphasizing challenges in managing treatment resistance.
- To evaluate the role of enteral nutrition and immunomodulatory agents in pediatric CD management.
- To discuss the emerging impact and ongoing safety considerations of biologic therapies, specifically anti-tumor necrosis factor-alpha agents.
Main Methods:
- Literature review of current therapeutic strategies for pediatric Crohn's disease.
- Analysis of the efficacy and safety profiles of standard medical therapies, including enteral nutrition and immunomodulators.
- Examination of recent advancements in biologic treatments and their implications for pediatric CD.
Main Results:
- Enteral nutrition demonstrates a favorable safety profile and positively influences growth and nutritional status in pediatric CD patients.
- Immunomodulating medications are crucial for maintaining remission and managing complex cases, including corticosteroid-dependent and perianal disease.
- Biologic therapy with infliximab has significantly altered treatment paradigms, though long-term safety data are still pending. Other biologics remain largely experimental.
Conclusions:
- Effective management of pediatric Crohn's disease requires a multi-faceted approach addressing clinical remission, growth, and quality of life.
- Enteral nutrition and immunomodulators remain vital components of therapy, particularly for treatment-resistant populations.
- Biologic therapies represent a significant advancement, necessitating continued research into their long-term efficacy and safety in pediatric populations.
Abstract:
The natural history of Crohn's disease is characterized by recurrent exacerbations. A small, but significant, number of pediatric patients with Crohn's disease are resistant to standard medical therapies. The goal of therapy in pediatric patients is not only to achieve and maintain clinical remission, but also to promote growth, development and improve quality of life. All of this needs to be achieved within a relatively short window of opportunity, before growth and development deficiencies become permanent. The standard therapy for pediatric patients with Crohn's disease consists of 5-aminosalicylic-acid compounds, antibiotics and enteral nutrition. Enteral nutrition has an excellent adverse-effect profile and, in addition to its therapeutic effect, positively impacts growth and nutritional status. Immunomodulating medications, such as azathioprine, 6-mercaptopurine and methotrexate, are frequently used to maintain remission, and to treat corticosteroid-dependent and perianal disease. Recently, biologic treatment with the anti-tumor-necrosis-factor-alpha antibody infliximab has dramatically changed the therapeutic approach. The long-term safety of this therapy still needs to be established. Limited data are available on other biologic therapies, which, at this point in time, are considered experimental and are only available through clinical trials.
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