Current therapy of inflammatory bowel disease in children

• Published in: Paediatric drugs 2006, Vol.8 (5), p.279-302
• Main Authors: Rufo, Paul A, Bousvaros, Athos
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents - therapeutic use; Child; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - epidemiology; Colitis, Ulcerative - physiopathology; Colitis, Ulcerative - therapy; Crohn Disease - diagnosis; Crohn Disease - epidemiology; Crohn Disease - physiopathology; Crohn Disease - therapy; Female; Gastrointestinal Agents - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Inflammatory Bowel Diseases - diagnosis; Inflammatory Bowel Diseases - epidemiology; Inflammatory Bowel Diseases - therapy; Nutrition Disorders - complications; Probiotics - therapeutic use
• ISSN: 1174-5878
• DOI: 10.2165/00148581-200608050-00002

Ulcerative colitis (UC) and Crohn disease (CD) are chronic intestinal inflammatory diseases that can present as bloody diarrhea, abdominal pain, and malnutrition. Collectively, these disorders are referred to as inflammatory bowel disease (IBD). All patients with IBD share a common pathophysiology. However, there are a number of developmental, psychosocial, and physiologic issues that are unique to the approximate, equals 20% of patients that present during childhood or adolescence. These include the possibility of disease-induced delays in linear growth or physical development, differences in drug dosing, and the changes in social and cognitive development that occur as children move from school-age years into adolescence and early adulthood. Gastroenterologists caring for these children must therefore develop an optimal regimen of pharmacologic therapies, nutritional management, psychologic support, and properly timed surgery (when necessary) that will maintain disease remission, minimize disease and drug-induced adverse effects, and optimize growth and development. This article reviews current approaches to the management of patients with UC and CD and highlights issues specific to the treatment of children with IBD. The principal medical therapies used to induce disease remission in patients with UC are aminosalicylates (for mild disease), corticosteroids (for moderate disease), and cyclosporine (ciclosporin) (for severe disease). If a patient responds to the induction regimen, maintenance therapies that are used to prevent disease relapse include aminosalicylates, mercaptopurine, and azathioprine. Colectomy with creation of an ileal pouch anal anastomosis (J pouch) has become the standard of care for patients with severe or refractory colitis and results in an improved quality of life in most patients. Therefore, the risks associated with using increasingly potent immunosuppressant agents must be balanced in each case against a patient's desire to retain their colon and avoid a temporary or potentially permanent ileostomy. Decisions about drug therapy in the management of patients with CD are more complex and depend on both the location (e.g. gastroduodenal vs small intestinal vs colonic), as well as the behavior of the disease (inflammatory/mucosal vs stricturing vs perforating) in a given patient. Induction therapies for CD typically include aminosalicylates and antibiotics (for mild mucosal disease), nutritional therapy (including elemental or poly