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Published on: December 1, 2012
Advances in the medical management of paediatric IBD
Marina Aloi1, Federica Nuti1, Laura Stronati2
1Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Viale Regina Elena 324, Rome 00161, Italy.
Insights
Pediatric inflammatory bowel disease (IBD) management has advanced beyond symptom control to deep remission using biologic agents. These disease-modifying drugs offer new hope for children with Crohn's disease and ulcerative colitis.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Inflammatory Bowel Disease (IBD) research
Background:
- Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, significantly impacts children's growth, nutrition, and emotional well-being.
- Traditional IBD therapy focused on symptom management, often leading to chronic morbidity and reduced quality of life.
Purpose of the Study:
- To review current knowledge on IBD treatment options for pediatric patients.
- To highlight the efficacy and safety of novel therapeutic advancements in managing pediatric IBD.
Main Methods:
- Review of current literature and clinical guidelines for pediatric IBD management.
- Analysis of therapeutic strategies, including conventional and biologic agents.
- Focus on recent advancements and pediatric-specific clinical trials.
Main Results:
- Therapeutic goals have shifted towards achieving mucosal healing and deep remission in pediatric IBD.
- Biologic agents, initially for refractory cases, show potential for early intervention in children to halt inflammation.
- Emergence of pediatric-specific, controlled, prospective, and randomized trials guiding management.
Conclusions:
- Modern IBD therapy in children aims for long-term remission and improved quality of life.
- Biologic therapies represent a significant advancement, with growing evidence for early use in pediatric IBD.
- The field is evolving with dedicated pediatric research, improving treatment protocols and outcomes for children with IBD.
Abstract:
IBD includes two classic entities, Crohn's disease and ulcerative colitis, and a third undetermined form (IBD-U), characterized by a chronic relapsing course resulting in a high rate of morbidity and impaired quality of life. Children with IBD are vulnerable in terms of growth failure, malnutrition and emotional effects. The aims of therapy have now transitioned from symptomatic control to the achievement of mucosal healing and deep remission. This type of therapy has been made possible by the advent of disease-modifying drugs, such as biologic agents, which are capable of interrupting the inflammatory cascade underlying IBD. Biologic agents are generally administered in patients who are refractory to conventional therapies. However, there is growing support that such agents could be used in the initial phases of the disease, typically in paediatric patients, to interrupt and cease the inflammatory process. Until several years ago, most therapeutic programmes in paediatric patients with IBD were borrowed from adult trials, whereas paediatric studies were often retrospective and uncontrolled. However, guidelines on therapeutic management of paediatric IBD and controlled, prospective, randomized trials including children with IBD have now been published. Here, the current knowledge concerning treatment options for children with IBD are reported. We also highlight the effectiveness and safety of new therapeutic advances in these paediatric patients.
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