Crohn’s disease in children: actual aspects of diagnosis and treatment according to modern international guidelines




Crohn’s disease, diagnosis, treatment, children, review


The article summarizes the knowledge about epidemiological data, clinical features, modern principles of diagnosis and treatment of Crohn’s disease in children based on the analysis of literature sources using paper and electronic databases PubMed, CyberLeninka, Web of Science, MedLine, The Cochrane Library. A review of literary sources on the study of this pathology demonstrates that at the present stage, the diagnosis of inflammatory bo­wel diseases, especially in young children, is still a complicated issue. The article focused on the complexity of the diagnostic search due to the not always typical course of the disease in childhood. Data are presented on the peculiarities of clinical course of the disease depending on localization of the pathological process. The author emphasizes the importance of early diagnosis of Crohn’s di­sease in order to provide immediate protocol treatment and the need for detecting this pathology already at the level of primary medical care. The article also presents data of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organisation on the necessary scope of methods for the diagnosis of Crohn’s disease in children according to the current international guidelines. The review describes the modern principles of treatment of Crohn’s disease in children, the main pharmacological groups of drugs that have a proven evidence base in pediatric practice. Particular attention is paid to the role of total enteral nutrition as the safest and quite effective direction of the initial therapy for this pathology in children. In conclusion, the author considered the problem of differential diagnosis of inflammatory bowel disease in pediatric practice.


Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis. 2011 Jan;17(1):423-439. doi:10.1002/ibd.21349.

Ruemmele FM, Veres G, Kolho KL, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis. 2014 Oct;8(10):1179-11207. doi:10.1016/j.crohns.2014.04.005.

Kugathasan S, Judd RH, Hoffmann RG, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr. 2003 Oct;143(4):525-531. doi:10.1067/s0022-3476(03)00444-x.

Duricova D, Fumery M, Annese V, Lakatos PL, Peyrin-Biroulet L, Gower-Rousseau C. The natural history of Crohn's disease in children: a review of population-based studies. Eur J Gastroenterol Hepatol. 2017 Feb;29(2):125-134. doi:10.1097/MEG.0000000000000761.

Kornienko EA, Krupina AN, Gabrusskaya TV, Kalinina NM. Inflammatory bowel disease with a very early onset. Almanac of Clinical Medicine. 2016;44(6):719-733. doi:10.18786/2072-0505-2016- 44-6-719-733. (in Russian).

Molchanov D. Crohn's disease in children: the state of the problem and prospects for its solution in Ukraine. Zdorov’ja Ukrai'ny. Gastroenterologija, gepatologija, koloproktologija. 2015;(35):10-11. (in Russian).

Levine A, Koletzko S, Turner D, et al. ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):795-806. doi:10.1097/MPG.0000000000000239.

Jose FA, Garnett EA, Vittinghoff E, et al. Development of extraintestinal manifestations in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2009 Jan;15(1):63-8. doi:10.1002/ibd.20604.

Naramore SK, Bennett WE Jr, Jiang G, et al. Serologic, but Not Genetic, Markers Are Associated With Impaired Anthropometrics at Diagnosis of Pediatric Crohn's Disease. J Pediatr Gastroenterol Nutr. 2019 Nov;69(5):e129-e134. doi:10.1097/MPG.0000000000002462.

Walters TD, Griffiths AM. Mechanisms of growth impairment in pediatric Crohn's disease. Nat Rev Gastroenterol Hepatol. 2009 Sep;6(9):513-23. doi:10.1038/nrgastro.2009.124.

Kapoor A, Bhatia V, Sibal A. Pediatric Inflammatory Bowel Disease. Indian Pediatr. 2016 Nov 15;53(11):993-1002. doi:10.1007/s13312-016-0975-0.

Aloi M, Cucchiara S. Extradigestive manifestations of IBD in pediatrics. Eur Rev Med Pharmacol Sci. 2009 Mar;13 Suppl 1:23-32.

Krjuchko TO, Nesina IM, Poda OA, Kolenko IO. Algorithm for differential diagnosis of intestinal diseases in children. Dytiachyi likar. 2016;(48):21-24. (in Ukrainian).

Henderson P, Anderson NH, Wilson DC. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2014 May;109(5):637-645. doi:10.1038/ajg.2013.131.

Chandrakumar A, Georgy M, Agarwal P, W't Jong G, El-Matary W. Anti-Saccharomyces cerevisiae Antibodies as a Prognostic Biomarker in Children With Crohn Disease. J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):82-87. doi:10.1097/MPG.0000000000002311.

Weiss B, Turner D, Griffiths A, et al. Simple Endoscopic Score of Crohn Disease and Magnetic Resonance Enterography in Children: Report From ImageKids Study. J Pediatr Gastroenterol Nutr. 2019 Oct;69(4):461-465. doi:10.1097/MPG.0000000000002404.

Chiorean L, Schreiber-Dietrich D, Braden B, et al. Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World J Gastroenterol. 2015 May 7;21(17):5231-5241. doi:10.3748/wjg.v21.i17.5231.

Guilhon de Araujo Sant'Anna AM, Dubois J, Miron MC, Seidman EG. Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial. Clin Gastroenterol Hepatol. 2005 Mar;3(3):264-270. doi:10.1016/s1542-3565(04)00715-3.

Hyams J, Markowitz J, Otley A, et al. Evaluation of the pediatric crohn disease activity index: a prospective multicenter experience. J Pediatr Gastroenterol Nutr. 2005 Oct;41(4):416-421. doi:10.1097/01.mpg.0000183350.46795.42.

Borrelli O, Cordischi L, Cirulli M, et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol. 2006 Jun;4(6):744-753. doi:10.1016/j.cgh.2006.03.010.

Ludvigsson JF, Krantz M, Bodin L, Stenhammar L, Lindquist B. Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial. Acta Paediatr. 2004 Mar;93(3):327-335.

Rodrigues AF, Johnson T, Davies P, Murphy MS. Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease? Arch Dis Child. 2007 Sep;92(9):767-770. doi:10.1136/adc.2006.103416.

Miele E, Shamir R, Aloi M, et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):687-708. doi:10.1097/MPG.0000000000001896.

Grogan JL, Casson DH, Terry A, Burdge GC, El-Matary W, Dalzell AM. Enteral feeding therapy for newly diagnosed pediatric Crohn's disease: a double-blind randomized controlled trial with two years follow-up. Inflamm Bowel Dis. 2012 Feb;18(2):246-253. doi:10.1002/ibd.21690.

Critch J, Day AS, Otley A, et al. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):298-305. doi:10.1097/MPG.0b013e318235b397.

Berni Canani R, Terrin G, Borrelli O, et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease. Dig Liver Dis. 2006 Jun;38(6):381-387. doi:10.1016/j.dld.2005.10.005.

Markowitz J, Grancher K, Kohn N, Lesser M, Daum F. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology. 2000 Oct;119(4):895-902. doi:10.1053/gast.2000.18144.

Levine A, Weizman Z, Broide E, et al. A comparison of budesonide and prednisone for the treatment of active pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2003 Feb;36(2):248-252. doi:10.1097/00005176-200302000-00017.

Levine A, Turner D. Combined azithromycin and metronidazole therapy is effective in inducing remission in pediatric Crohn's disease. J Crohns Colitis. 2011 Jun;5(3):222-226. doi:10.1016/j.crohns.2011.01.006.

Chatu S, Subramanian V, Saxena S, Pollok RC. The role of thiopurines in reducing the need for surgical resection in Crohn's disease: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Jan;109(1):23-34; quiz 35. doi:10.1038/ajg.2013.402.

Willot S, Noble A, Deslandres C. Methotrexate in the treatment of inflammatory bowel disease: an 8-year retrospective study in a Canadian pediatric IBD center. Inflamm Bowel Dis. 2011 Dec;17(12):2521-6. doi:10.1002/ibd.21653.

Skrypnyk IM. Inflammatory bowel disease: 14th Congress of the European Organization for the Study of Crohn's Disease and Colitis (ECCO). Modern Gastroenterology. 2019;(107):107-108. doi:10.30978/MG-2019-3-107. (in Ukrainian).

Ruemmele FM, Lachaux A, Cézard JP, et al. Efficacy of infliximab in pediatric Crohn's disease: a randomized multicenter open-label trial comparing scheduled to on demand maintenance therapy. Inflamm Bowel Dis. 2009 Mar;15(3):388-394. doi:10.1002/ibd.20788.

Dupont-Lucas C, Dabadie A, Alberti C, Ruemmele FM; GETAID (Group d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif) Pédiatrique. Predictors of response to infliximab in paediatric perianal Crohn's disease. Aliment Pharmacol Ther. 2014 Oct;40(8):917-929. doi:10.1111/apt.12928.

Rosh JR, Lerer T, Markowitz J, et al. Retrospective Evaluation of the Safety and Effect of Adalimumab Therapy (RESEAT) in pediatric Crohn's disease. Am J Gastroenterol. 2009 Dec;104(12):3042-3049. doi:10.1038/ajg.2009.493.

Cameron FL, Wilson ML, Basheer N, et al. Anti-TNF therapy for paediatric IBD: the Scottish national experience. Arch Dis Child. 2015 Apr;100(4):399-405. doi:10.1136/archdischild-2013-305812.





Review of Literature