Current therapy of pediatric Crohn’s disease

Abstract

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis, are chronic relapsing and remitting diseases of the bowel, with an unknown etiology and appear to involve interaction between genetic susceptibility, environmental factors and the immune system. Although our knowledge and understanding of the pathogenesis and causes of IBD have improved significantly, the incidence in the pediatric population is still rising. In the last decade more drugs and treatment option have become available including 5-aminosalicylate, antibiotics, corticosteroids, immunomodulators and biological agents. Before the use of anti-tumor necrosis factor (TNF)-α became available to patients with IBD, the risk for surgery within five years of diagnosis was very high, however, with anti-TNF-α treatment the risk of surgery has decreased significantly. In the pediatric population a remission in disease can be achieved by exclusive enteral nutrition. Exclusive enteral nutrition also has an important role in the improvement of nutritional status and maintained growth. In this review we summarize the current therapeutic treatments in CD. The progress in the treatment options and the development of new drugs has led to optimized tactics for achieving the primary clinical goals of therapy - induction and maintenance of remission while improving the patient’s growth and overall well-being.

Keywords: Pediatric Crohn’s disease; Immunomodulators; Antibiotics; Nutrition; Anti-tumor necrosis factor; Steroids; 5-aminosalicylic acid

Core tip: Inflammatory bowel diseases are chronic relapsing diseases of the bowel, with an unknown etiology, rising incidence in the pediatric population, and increasing therapeutic options. The therapeutic goal has changed over the last decade towards accelerated step up or top down therapy with a goal of achieving mucosal healing and perhaps changing the disease course. In this review we discuss these therapeutic approaches.