Summary
It has been more than ten years since the Dutch paediatric ibd working group published its national consensus guideline on diagnosis and treatment. As clinical studies in children with ibd were scarce, guidelines were largely based on expert opinion instead of clinical evidence from the literature. In the preceding decennium, government, ethics committees and industry have become increasingly convinced of the need for clinical studies in children. As a result, the number of clinical studies in children has clearly grown. For children and adolescents with ibd, recent studies have yielded the evidence to support the old guidelines on diagnosis. Results of drug trials have brought new insight into the medical treatment of children with Crohn's disease, ulcerative colitis or indeterminate colitis.
Samenvatting
Het is nu ruim tien jaar geleden dat de cbo-consensus ibd bij kinderen werd gepubliceerd. In de consensustekst werd een aantal aanbevelingen gedaan voor de diagnostiek en behandeling van deze kinderen en adolescenten. Door het gebrek aan klinische onderzoeken bij kinderen met ibd waren deze aanbevelingen grotendeels gebaseerd op ‘expert opinion’, in plaats van op ‘evidence’. Het afgelopen decennium is echter bij overheid, medisch-ethische commissies en farmaceutische industrie het besef gegroeid dat klinisch onderzoek bij kinderen essentieel is om tot een juiste behandeling te komen. Het gevolg is dat het aantal klinische onderzoeken bij kinderen duidelijk is toegenomen. Bij kinderen met ibd heeft dit geleid tot ondersteuning van de consensustekst betreffende de diagnostiek en veranderde inzichten aangaande de medicamenteuze behandeling.
Literatuur
Lashner BA. In: Stein SH, Rood, RP, eds. Inflammatory bowel disease: A guide for patients and their families. Philadelphia: Lippincott-Raven, 1999. p. 23-9.
Büller HA, Maas SM. Consensus inflammatoire darmziekte bij kinderen: colitis ulcerosa en ziekte van Crohn. Ned Tijdschr Geneeskd 1996;140:544-50.
Motil KJ, Grand RJ, Davis-Kraft L, et al. Growth failure in children with inflammatory bowel disease: a prospective study. Gastroenterology 1993;105:681-91.
Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child 2003;88:995-1000.
Russell RK, Satsangi J. IBD: a family affair. Best Pract Res Clin Gastroenterol 2004;18:525-39.
Abdullah BA, Gupta SK, Croffie JM, et al. The role of esophagogastroduodenoscopy in the initial evaluation of childhood inflammatory bowel disease: a 7-year study. J Pediatr Gastroenterol Nutr 2002;35:636-40.
Castellaneta SP, Afzal NA, Greenberg M, et al. Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2004; 39:257-61.
Kundhal PS, Stormon MO, Zachos M, et al. Gastral antral biopsy in the differentiation of pediatric colitides. Am J Gastroenterol 2003;98:557-61.
Seidman EG, Sant'Anna AM, Dirks MH. Potential applications of wireless capsule endoscopy in the pediatric age group. Gastrointest Endosc Clin N Am 2004;14:207-17.
Halligan S, Nicholls S, Beattie RM, et al. The role of small bowel radiology in the diagnosis and management of Crohn's disease. Acta Paediatr 1995;84:1375-8.
Darbari A, Sena L, Argani P, et al. Gadolinium-enhanced magnetic resonance imaging: a useful radiological tool in diagnosing pediatric IBD. Inflamm Bowel Dis 2004;10:67-72.
Boot AM, Bouquet J, Krenning EP, Muinck Keizer-Schrama SM de. Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut 1998;42:188-94.
Escher JC, Taminiau JA, Nieuwenhuis EE, et al. Treatment of inflammatory bowel disease in childhood: best available evidence. Inflamm Bowel Dis 2003;9:34-58.
Griffiths A, Koletzko S, Sylvester F, et al. Slow-release 5-aminosalicylic acid therapy in children with small intestinal Crohn's disease. J Pediatr Gastroenterol Nutr 1993;17:186-92.
Hanauer SB, Stromberg U. Oral Pentasa in the treatment of active Crohn's disease: A meta-analysis of double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol 2004;2:379-88.
Cottone M, Camma C. Mesalamine and relapse prevention in Crohn's disease. Gastroenterology 2000;119:597.
Szumlanski CL, Weinshilboum RM. Sulphasalazine inhibition of thiopurine methyltransferase: possible mechanism for interaction with 6-mercaptopurine and azathioprine. Br J Clin Pharmacol 1995;39:456-9.
Glintborg B. Pancreatitis in a patient with Crohn disease treated with mesalazine and azathioprine [in het Deens]. Ugeskr Laeger 2000;162:4553-4.
Beattie RM, Nicholls SW, Domizio P, et al. Endoscopic assessment of the colonic response to corticosteroids in children with ulcerative colitis. J Pediatr Gastroenterol Nutr 1996;22:373-9.
Munkholm P, Langholz E, Davidsen M, Binder V. Frequency of glucocorticoid resistance and dependency in Crohn's disease. Gut 1994;35:360-2.
D'Haens G. Mucosal healing in pediatric Crohn's disease: the goal of medical treatment. Inflamm Bowel Dis 2004;10:479-80.
Heuschkel RB, Menache CC, Megerian JT, Baird AE. Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children. J Pediatr Gastroenterol Nutr 2000;31:8-15.
Markowitz J, Grancher K, Kohn N, et al. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology 2000;119:895-902.
Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet 2002;359:1541-9.
Kugathasan S, Werlin SL, Martinez A, et al. Prolonged duration of response to infliximab in early but not late pediatric Crohn's disease. Am J Gastroenterol 2000;95:3189-94.
Lionetti P, Bronzini F, Salvestrini C, et al. Response to infliximab is related to disease duration in paediatric Crohn's disease. Aliment Pharmacol Ther 2003;18:425-31.
Griffiths AM. Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin Gastroenterol 2004;18:509-23.
Gemert WG van, Heurn LWE van, Soeters PB. De chirurgische behandeling van de ziekte van Crohn en colitis ulcerosa bij kinderen. Tijdschr Kindergeneeskd 2005;73:26-30.
Damen GM, Nieuwenhuis EES. Niet-invasieve markers bij inflammatoire darmziekten op de kinderleeftijd. Tijdschr Kindergeneeskd 2005;73:17-21.
Ridder L de, Hommes DW, Benninga MA, Taminiau JAJM. Anti-TNF-behandeling bij de ziekte van Crohn. Tijdschr Kindergeneeskd 2005;73:21-26.
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Mw.dr. J.C. (Hankje) Escher, kinderarts/gastro-enteroloog, afdeling Kindergastro-enterologie, Erasmus mc-Sophia Kinderziekenhuis, Rotterdam.
Correspondentieadres: Dr. J.C. Escher, afdeling Kindergastro-enterologie, Erasmus mc-Sophia Kinderziekenhuis, Postbus 2060, 3000 CB Rotterdam, tel: 010-4637093, fax: 010-4636811
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Escher, J.C. Diagnose en behandeling van inflammatoire darmziekten bij kinderen anno 2005. KIND 73, 233–239 (2005). https://doi.org/10.1007/BF03061585
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DOI: https://doi.org/10.1007/BF03061585