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Published on: September 20, 2018
Diagnostic and Therapeutic Approach in Paediatric Inflammatory Bowel Diseases: Results from a Clinical Practice
Jiri Bronsky1, Lissy de Ridder2, Frank M Ruemmele3
1Department of Paediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
Insights
Pediatric inflammatory bowel disease (IBD) centers largely follow international guidelines for diagnosis and treatment. However, variations in clinical practice for Crohn disease (CD) and ulcerative colitis (UC) persist despite established protocols.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Practice Guidelines
Background:
- International guidelines exist for pediatric inflammatory bowel diseases (IBD).
- Clinical practice may vary among different centers despite these guidelines.
- Understanding current approaches is crucial for optimizing care.
Purpose of the Study:
- To assess current clinical practice in pediatric IBD management.
- To identify adherence to international diagnostic and treatment guidelines.
- To explore variations in therapeutic strategies across centers.
Main Methods:
- A web-based questionnaire was distributed to pediatric IBD centers.
- Members of ESPGHAN Porto IBD working group, PIBD-NET, and IBD networks in Canada and German-speaking countries participated.
- Responses from 106 centers were collected and analyzed.
Main Results:
- 84% of centers reported adherence to revised Porto criteria.
- Exclusive enteral nutrition is a common first-line therapy for luminal Crohn disease (CD).
- Immunomodulators (IMM) are widely used, with infliximab (IFX) often being the first-line biologic; biosimilar use is increasing.
- 5-aminosalicylates are frequently used with IMM in ulcerative colitis (UC), and azathioprine (AZA) monotherapy is preferred post-surgery for CD.
Conclusions:
- Most centers align with Porto diagnostic criteria and ESPGHAN/ECCO guidelines.
- This adherence highlights the impact of international guidelines on pediatric IBD care.
- Potential for response bias exists, as motivated individuals may overrepresent daily practice.
Objectives:
Despite existence of international guidelines for diagnosis and management of inflammatory bowel diseases (IBD) in children, there might be differences in the clinical approach.
Methods:
A survey on clinical practice in paediatric IBD was performed among members of the ESPGHAN Porto IBD working group and interest group, PIBD-NET, and IBD networks in Canada and German-speaking countries (CIDsCANN, GPGE), using a web-based questionnaire. Responses to 63 questions from 106 paediatric IBD centres were collected.
Results:
Eighty-four percentage of centres reported to fulfil the revised Porto criteria in the majority of patients. In luminal Crohn disease (CD), exclusive enteral nutrition is used as a first-line induction therapy and immunomodulators (IMM) are used since diagnosis in the majority of patients. Infliximab (IFX) is mostly considered as first-line biological. Sixty percentage of centres have experience with vedolizumab and/or ustekinumab and 40% use biosimilars. In the majority of ulcerative colitis (UC) patients 5-aminosalicylates are continued as concomitant therapy to IMM (usually azathioprine [AZA]/6-MP). After ileocaecal resection (ICR) in CD patients without postoperative residual disease, AZA monotherapy is the preferred treatment.
Conclusions:
A majority of centres follows both the Porto diagnostic criteria as well as paediatric (ESPGHAN/ECCO) guidelines on medical and surgical IBD management. This reflects the value of international societal guidelines. However, potentially desirable answers might have been given instead of what is true daily practice, and the most highly motivated people might have answered, leading to some bias.
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