Treatment of inflammatory bowel disease in childhood:: Best available evidence

被引:90
作者
Escher, JC
Taminiau, JAJM
Nieuwenhuis, EES
Büller, HA
Grand, RJ
机构
[1] Erasmus Univ, Sophia Childrens Hosp, Dept Pediat, NL-3015 GJ Rotterdam, Netherlands
[2] Univ Amsterdam, Emma Childrens Hosp, Acad Med Ctr, Dept Pediat Gastroenterol, NL-1012 WX Amsterdam, Netherlands
[3] Childrens Hosp, Ctr Inflammatory Bowel Dis, Div Gastroenterol & Nutr, Boston, MA USA
[4] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Gastroenterol, Boston, MA 02115 USA
关键词
review; therapy; children; inflammatory bowel disease; enteral nutrition;
D O I
10.1097/00054725-200301000-00006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The physician treating children with inflammatory bowel disease is confronted with a number of specific problems, one of them being the lack of randomized, controlled drug trials in children. In this review, the role of nutritional therapy is discussed with a focus on primary treatment, especially for children with Crohn's disease. Then, the available medical therapies are highlighted, reviewing the evidence of effectiveness and side effects in children, as compared with what is known in adults. Nutritional therapy has proven to be effective in inducing and maintaining remission in Crohn's disease while promoting linear growth. Conventional treatment consists of aminosalicylates and corticosteroids, whereas the early introduction of immunosuppressives (such as azathioprine or 6-mercaptopurine) is advocated as maintenance treatment. If these drug., are not tolerated or are ineffective, methotrexate may serve as an alternative in Crohn's disease. Cyclosporine is an effective rescue therapy in severe ulcerative colitis, but only will postpone surgery. A novel strategy to treat Crohn's disease is offered by infliximab, a monoclonal antibody to the proinflammatory cytokine tumor necrosis factor (TNF)-alpha. Based on the best-available evidence, suggested usage is provided for separate drugs with respect to dosage and monitoring of side effects in children.
引用
收藏
页码:34 / 58
页数:25
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