Jiri Bronsky1, Lissy de Ridder2, Frank M Ruemmele3, Anne Griffiths4, Stephan Buderus5, Ondrej Hradsky1, Almuthe Christina Hauer6. 1. Department of Paediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. 2. Department of Paediatric Gastroenterology, The Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands. 3. Department of Paediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France. 4. Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 5. Department of Paediatrics, St. Marien Hospital, Bonn, Germany. 6. GPGE-Educational Center for Paediatric Gastroenterology, Department of Paediatrics, Medical University of Graz, Graz, Austria.
Abstract
OBJECTIVES: Despite existence of international guidelines for diagnosis and management of inflammatory bowel diseases (IBD) in children, there might be differences in the clinical approach. METHODS: A survey on clinical practice in paediatric IBD was performed among members of the ESPGHAN Porto IBD working group and interest group, PIBD-NET, and IBD networks in Canada and German-speaking countries (CIDsCANN, GPGE), using a web-based questionnaire. Responses to 63 questions from 106 paediatric IBD centres were collected. RESULTS: Eighty-four percentage of centres reported to fulfil the revised Porto criteria in the majority of patients. In luminal Crohn disease (CD), exclusive enteral nutrition is used as a first-line induction therapy and immunomodulators (IMM) are used since diagnosis in the majority of patients. Infliximab (IFX) is mostly considered as first-line biological. Sixty percentage of centres have experience with vedolizumab and/or ustekinumab and 40% use biosimilars. In the majority of ulcerative colitis (UC) patients 5-aminosalicylates are continued as concomitant therapy to IMM (usually azathioprine [AZA]/6-MP). After ileocaecal resection (ICR) in CD patients without postoperative residual disease, AZA monotherapy is the preferred treatment. CONCLUSIONS: A majority of centres follows both the Porto diagnostic criteria as well as paediatric (ESPGHAN/ECCO) guidelines on medical and surgical IBD management. This reflects the value of international societal guidelines. However, potentially desirable answers might have been given instead of what is true daily practice, and the most highly motivated people might have answered, leading to some bias.
OBJECTIVES: Despite existence of international guidelines for diagnosis and management of inflammatory bowel diseases (IBD) in children, there might be differences in the clinical approach. METHODS: A survey on clinical practice in paediatric IBD was performed among members of the ESPGHAN Porto IBD working group and interest group, PIBD-NET, and IBD networks in Canada and German-speaking countries (CIDsCANN, GPGE), using a web-based questionnaire. Responses to 63 questions from 106 paediatric IBD centres were collected. RESULTS: Eighty-four percentage of centres reported to fulfil the revised Porto criteria in the majority of patients. In luminal Crohn disease (CD), exclusive enteral nutrition is used as a first-line induction therapy and immunomodulators (IMM) are used since diagnosis in the majority of patients. Infliximab (IFX) is mostly considered as first-line biological. Sixty percentage of centres have experience with vedolizumab and/or ustekinumab and 40% use biosimilars. In the majority of ulcerative colitis (UC) patients5-aminosalicylates are continued as concomitant therapy to IMM (usually azathioprine [AZA]/6-MP). After ileocaecal resection (ICR) in CDpatients without postoperative residual disease, AZA monotherapy is the preferred treatment. CONCLUSIONS: A majority of centres follows both the Porto diagnostic criteria as well as paediatric (ESPGHAN/ECCO) guidelines on medical and surgical IBD management. This reflects the value of international societal guidelines. However, potentially desirable answers might have been given instead of what is true daily practice, and the most highly motivated people might have answered, leading to some bias.
Authors: Melinda Moriczi; Gemma Pujol-Muncunill; Rafael Martín-Masot; Santiago Jiménez Treviño; Oscar Segarra Cantón; Carlos Ochoa Sangrador; Luis Peña Quintana; Daniel González Santana; Alejandro Rodríguez Martínez; Antonio Rosell Camps; Honorio Armas; Josefa Barrio; Rafael González de Caldas; Mónica Rodríguez Salas; Elena Balmaseda Serrano; Ester Donat Aliaga; Andrés Bodas Pinedo; Esther Vaquero Sosa; Raquel Vecino López; Alfonso Solar Boga; Ana Moreno Álvarez; César Sánchez Sánchez; Mar Tolín Hernani; Carolina Gutiérrez Junquera; Nazareth Martinón Torres; María Rosaura Leis Trabazo; Francisco Javier Eizaguirre; Mónica García Peris; Enrique Medina Benítez; Beatriz Fernández Caamaño; Ana María Vegas Álvarez; Laura Crespo Valderrábano; Carmen Alonso Vicente; Javier Rubio Santiago; Rafael Galera-Martínez; Ruth García-Romero; Ignacio Ros Arnal; Santiago Fernández Cebrián; Helena Lorenzo Garrido; Javier Francisco Viada Bris; Marta Velasco Rodríguez-Belvis; Juan Manuel Bartolomé Porro; Miriam Blanco Rodríguez; Patricia Barros García; Gonzalo Botija; Francisco José Chicano Marín; Enrique La Orden Izquierdo; Elena Crehuá-Gaudiza; Víctor Manuel Navas-López; Javier Martín-de-Carpi Journal: Nutrients Date: 2020-04-07 Impact factor: 5.717