Crohn’s disease in childhood: modern approaches to treatment (a literature review)
DOI:
https://doi.org/10.14739/2310-1210.2021.2.207286Keywords:
Crohn’s disease, children, treatmentAbstract
The aim of the work. To provide world experience and features of Crohn’s disease (CD) treatment in children by reviewing and analyzing modern scientific literary sources, given the need to develop a unified therapeutic strategy for CD in childhood.
The relevance of CD treatment in children stems from its debut in childhood in a large number of patients, in connection with this, a more severe and aggressive course; the presence of various surgical complications, a high risk of malignancy, and the absence of generally accepted approaches to conservative and surgical treatment. The analysis of the results of modern scientific and clinical studies on the treatment of CD in children with the characteristics of drug groups and their individual representatives, methods of treatment for patients with surgical complications of CD in childhood, lifestyle correction, psychosocial adaptation, enteral nutrition, rehabilitation, and dispensary observation is presented. The principle of a cascade approach to the treatment of CD is illustrated by an example of the WGO recommendations.
Conclusions. The treatment of CD should be individual and comprehensive, with the simultaneous correction of local manifestations of the disease, surgical complications and changes in the general condition of a patient, as well as with dieting and lifestyle correction. The expected therapeutic effect of the use in children with CD of a large number of the proposed groups of medications is debatable or clinically unproven, which necessitates the implementation of further scientific and clinical research. The information presented will help doctors determine the optimal range of individual medical, rehabilitation measures and recommendations for everyone with CD in childhood and effectively provide active follow-up for patients.
References
Dotson, J. L., Bashaw, H., Nwomeh, B., & Crandall, W. V. (2015). Management of Intra-abdominal Abscesses in Children With Crohn's Disease: A 12-year, Retrospective Single-center Review. Inflammatory Bowel Diseases, 21(5), 1109-1114. https://doi.org/10.1097/MIB.0000000000000361
Lourenço, R., Azevedo, S., & Lopes, A. I. (2016). Surgery in Pediatric Crohn Disease: Case Series from a Single Tertiary Referral Center. GE Portuguese Journal of Gastroenterology, 23(4), 191-196. https://doi.org/10.1016/j.jpge.2016.03.007
Glassner, K. L., Abraham, B. P., & Quigley, E. (2020). The microbiome and inflammatory bowel disease. Journal of Allergy and Clinical Immunology, 145(1), 16-27. https://doi.org/10.1016/j.jaci.2019.11.003
Sherlock, M. E., & Benchimol, E. I. (2017). Classification of Inflammatory Bowel Disease in Children. In P. Mamula, A. Grossman, R. Baldassano, J. Kelsen, & J. Markowitz (Eds.), Pediatric Inflammatory Bowel Disease (3rd ed., pp.181-191). Springer, Cham. https://doi.org/10.1007/978-3-319-49215-5_15
Kornienko, E. A., Krupina, A. N., Gabrusskaya, T. V., & Kalinina, N. M. (2016). Vospalitel'nye zabolevaniya kishechnika s ochen' rannim nachalom [Inflammatory bowel disease with a very early onset]. Al'manakh klinicheskoi meditsiny, 44(6), 719-733. https://doi.org/10.18786/2072-0505-2016-44-6-719-733 [in Russian].
Ivashkin, V. T., Shelygin, Yu. A., Khalif, I. L., Belousova, E. A., Shifrin, O. S., Abdulganieva, D. I., Abdulkhakov, R. A., Alekseeva, O. P., Alekseenko, S. A., Achkasov, S. I., Baranovskii, A. Yu., Bolikhov, K. V., Valuiskikh, E. Yu., Vardanyan, A.V., Veselov, A. V., Veselov, V. V., Golovenko, A. O., Golovenko, O. V., Grigor'ev, E. G., … Yakovlev, A. A. (2017). Klinicheskie rekomendatsii Rossiiskoi gastroenterologicheskoi assotsiatsii i assotsiatsii koloproktologov Rossii po diagnostike i lecheniyu bolezni Krona [Clinical guide of Russian Association of Gastroenterology and Russian Association of Coloproctology on diagnostics and treatment of Crohn's disease]. Koloproktologiya, (2), 7-29. https://doi.org/10.33878/2073-7556-2017-0-2-7-29 [in Russian].
Ashton, J. J., Mossotto, E., Ennis, S., & Beattie, R. M. (2019). Personalising medicine in inflammatory bowel disease - current and future perspectives. Translational Pediatrics, 8(1), 56-69. https://doi.org/10.21037/tp.2018.12.03
Duricova, D., Fumery, M., Annese, V., Lakatos, P. L., Peyrin-Biroulet, L., & Gower-Rousseau, C. (2017). The natural history of Crohn's disease in children: a review of population-based studies. European Journal of Gastroenterology & Hepatology, 29(2), 125-134. https://doi.org/10.1097/MEG.0000000000000761
Benchimol, E. I., Bernstein, C. N., Bitton, A., Carroll, M. W., Singh, H., Otley, A. R., Vutcovici, M., El-Matary, W., Nguyen, G. C., Griffiths, A. M., Mack, D. R., Jacobson, K., Mojaverian, N., Tanyingoh, D., Cui, Y., Nugent, Z. J., Coulombe, J., Targownik, L. E., Jones, J. L., Leddin, D., … Kaplan, G. G. (2017). Trends in Epidemiology of Pediatric Inflammatory Bowel Disease in Canada: Distributed Network Analysis of Multiple Population-Based Provincial Health Administrative Databases. American Journal of Gastroenterology, 112(7), 1120-1134. https://doi.org/10.1038/ajg.2017.97
Amil-Dias, J., Kolacek, S., Turner, D., Pærregaard, A., Rintala, R., Afzal, N. A., Karolewska-Bochenek, K., Bronsky, J., Chong, S., Fell, J., Hojsak, I., Hugot, J. P., Koletzko, S., Kumar, D., Lazowska-Przeorek, I., Lillehei, C., Lionetti, P., Martin-de-Carpi, J., Pakarinen, M., Ruemmele, F. M., … IBD Working Group of ESPGHAN (IBD Porto Group). (2017). Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 64(5), 818-835. https://doi.org/10.1097/MPG.0000000000001562
Di Caro, S., Fragkos, K. C., Keetarut, K., Koo, H. F., Sebepos-Rogers, G., Saravanapavan, H., Barragry, J., Rogers, J., Mehta, S. J., & Rahman, F. (2019). Enteral Nutrition in Adult Crohn's Disease: Toward a Paradigm Shift. Nutrients, 11(9), Article 2222. https://doi.org/10.3390/nu11092222
Stepanov, Yu. M., Stoykevich, M. V., & Sorochan, O. V. (2016). Zastosuvannia preparativ 5-aminosalitsylovoi kysloty v likuvanni zapalnykh zakhvoriuvan kyshechnyka [Application of 5-aminosalicylic acid preparations in the treatment of inflammatory bowel diseases]. Hastroenterolohiia, (3), 80-87. https://doi.org/10.22141/2308-2097.3.61.2016.79163 [in Ukrainian].
Bernstein, C. N., Eliakim, A., Fedail, S., Fried, M., Gearry, R., Goh, K. L., Hamid, S., Khan, A. G., Khalif, I., Ng, S. C., Ouyang, Q., Rey, J. F., Sood, A., Steinwurz, F., Watermeyer, G., LeMair, A., & Review Team. (2016). World Gastroenterology Organisation Global Guidelines Inflammatory Bowel Disease: Update August 2015. Journal of Clinical Gastroenterology, 50(10), 803-818. https://doi.org/10.1097/MCG.0000000000000660
Warner, B., Johnston, E., Arenas-Hernandez, M., Marinaki, A., Irving, P., & Sanderson, J. (2018). A practical guide to thiopurine prescribing and monitoring in IBD. Frontline Gastroenterology, 9(1), 10-15. https://doi.org/10.1136/flgastro-2016-100738
Walker, R., Kammermeier, J., Vora, R., & Mutalib, M. (2019). Azathioprine dosing and metabolite measurement in pediatric inflammatory bowel disease: does one size fit all? Annals of Gastroenterology, 32(4), 387-391. https://doi.org/10.20524/aog.2019.0381
Goyal, S., Ramawat, K. G., & Mérillon, J. M. (2017). Different Shades of Fungal Metabolites: An Overview. In J. M. Mérillon, K. Ramawat (Eds.), Fungal Metabolites (pp. 1-29). Springer, Cham. https://doi.org/10.1007/978-3-319-25001-4_34
Christensen, B., Gibson, P. R., Micic, D., Colman, R. J., Goeppinger, S. R., Kassim, O., Yarur, A., Weber, C. R., Cohen, R. D., & Rubin, D. T. (2019). Safety and Efficacy of Combination Treatment With Calcineurin Inhibitors and Vedolizumab in Patients With Refractory Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology, 17(3), 486-493. https://doi.org/10.1016/j.cgh.2018.04.060
Seyfried, S., & Herold, A. (2019). Management of Perianal Fistulas in Crohn's Disease. Visceral Medicine, 35(6), 338-343. https://doi.org/10.1159/000504103
Jia, K., Tong, X., Wang, R., & Song, X. (2018). The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis. Medicine, 97(51), Article e13792. https://doi.org/10.1097/MD.0000000000013792
Fehmel, E., Teague, W. J., Simpson, D., McLeod, E., Hutson, J. M., Rosenbaum, J., Oliver, M., Alex, G., & King, S. K. (2018). The burden of surgery and postoperative complications in children with inflammatory bowel disease. Journal of Pediatric Surgery, 53(12), 2440-2443. https://doi.org/10.1016/j.jpedsurg.2018.08.030
Lim, D. R., Kuk, J. C., Kim, T., Woo, C. G., Kim, H. K., & Shin, E. J. (2016). Spontaneous Free Perforated Small Bowel (Jejunum) in Crohn Disease: A Case Report. Surgical Infections Case Reports, 1(1), 128-131. https://doi.org/10.1089/crsi.2016.0035
Spekhorst, L. M., Visschedijk, M. C., Alberts, R., Festen, E. A., van der Wouden, E. J., Dijkstra, G., Weersma, R. K., & Dutch Initiative on Crohn and Colitis. (2014). Performance of the Montreal classification for inflammatory bowel diseases. World Journal of Gastroenterology, 20(41), 15374-15381. https://doi.org/10.3748/wjg.v20.i41.15374
Spiceland, C. M., & Lodhia, N. (2018). Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment. World Journal of Gastroenterology, 24(35), 4014-4020. https://doi.org/10.3748/wjg.v24.i35.4014
Koriche, D., Gower-Rousseau, C., Chater, C., Duhamel, A., Salleron, J., Tavernier, N., Colombel, J. F., Pariente, B., Cortot, A., & Zerbib, P. (2017). Post-operative recurrence of Crohn's disease after definitive stoma: an underestimated risk. International Journal of Colorectal Disease, 32(4), 453-458. https://doi.org/10.1007/s00384-016-2707-2
Cocorullo, G., Tutino, R., Falco, N., Salamone, G., Fontana, T., Licari, L., & Gulotta, G. (2016). Laparoscopic ileocecal resection in acute and chronic presentations of Crohn's disease. A single center experience. Giornale Di Chirurgia, 37(5), 220-223. https://doi.org/10.11138/gchir/2016.37.5.220
Martí-Gallostra, M., Myrelid, P., Mortensen, N., Keshav, S., Travis, S. P., & George, B. (2017). The role of a defunctioning stoma for colonic and perianal Crohn's disease in the biological era. Scandinavian Journal of Gastroenterology, 52(3), 251-256. https://doi.org/10.1080/00365521.2016.1205127
Kim, S. (2017). Surgery in Pediatric Crohn's Disease: Indications, Timing and Post-Operative Management. Pediatric Gastroenterology, Hepatology & Nutrition, 20(1), 14-21. https://doi.org/10.5223/pghn.2017.20.1.14
Gutiérrez, A., Rivero, M., Martín-Arranz, M. D., García Sánchez, V., Castro, M., Barrio, J., de Francisco, R., Barreiro-de Acosta, M., Juliá, B., Cea-Calvo, L., Romero, C., Borruel Sainz, N., & Domènech, E. (2019). Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn's disease: analysis from the PRACTICROHN study. Gastroenterology Report, 7(3), 168-175. https://doi.org/10.1093/gastro/goz010
Zimmerman, L. A., Saites, C. G., Bairdain, S., Lien, C., Zurakowski, D., Shamberger, R. C., Linden, B. C., & Bousvaros, A. (2016). Postoperative Complications in Children With Crohn Disease Treated With Infliximab. Journal of Pediatric Gastroenterology and Nutrition, 63(3), 352-356. https://doi.org/10.1097/MPG.0000000000001151
Candia, R., Naimark, D., Sander, B., & Nguyen, G. C. (2017). Cost-utility Analysis: Thiopurines Plus Endoscopy-guided Biological Step-up Therapy is the Optimal Management of Postoperative Crohn's Disease. Inflammatory Bowel Diseases, 23(11), 1930-1940. https://doi.org/10.1097/MIB.0000000000001233
Diederen, K., de Ridder, L., van Rheenen, P., Wolters, V. M., Mearin, M. L., Damen, G. M., de Meij, T. G., van Wering, H., Tseng, L. A., Oomen, M. W., de Jong, J. R., Sloots, C. E., Benninga, M. A., & Kindermann, A. (2017). Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis. Inflammatory Bowel Diseases, 23(2), 272-282. https://doi.org/10.1097/MIB.0000000000000999
Soleiko, D. S., Horbatiuk, O. M., Soleiko, N. P., & Soleiko, V. V. (2020). Suchasni pryntsypy diahnostyky khvoroby Krona v ditei [Modern principles of Crohn’s disease diagnosis in children]. Zaporozhye medical journal, 22(3), 411-419. https://doi.org/10.14739/2310-1210.2020.3.204957 [in Ukrainian].
Doherty, G., Katsanos, K. H., Burisch, J., Allez, M., Papamichael, K., Stallmach, A., Mao, R., Berset, I. P., Gisbert, J. P., Sebastian, S., Kierkus, J., Lopetuso, L., Szymanska, E., & Louis, E. (2018). European Crohn's and Colitis Organisation Topical Review on Treatment Withdrawal ['Exit Strategies'] in Inflammatory Bowel Disease. Journal of Crohn's and Colitis, 12(1), 17-31. https://doi.org/10.1093/ecco-jcc/jjx101
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