Current Therapy of Inflammatory Bowel Disease in Children

Abstract

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 polymeric formulas), corticosteroids (for moderate disease), and infliximab (for corticosteroid-resistant or fistulizing disease). Aminosalicylates, mercaptopurine, azathioprine, methotrexate, and infliximab can be used as maintenance therapies. Because surgical treatment of CD is not curative, it is typically reserved for those patients either with persistent symptoms and disease limited to a small section of the intestine (e.g. the terminal ileum and cecum) or for the management of complications of the disease including stricture or abdominal abscess. When surgery...

Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients

“…Therefore, rational and effective nutrition support will be conductive to malnutrition cancer patients. It has been previously reported that the function of small intestine usually began to recover within 6~12 h after operations (8), indicating the possibility of initiating EN support. Early postoperative EN rather than parenteral nutrition is advocated by researchers when intestines can normally work (9), which thus allows the wide application of EN support in clinical practice.…”

The Efficacy of Oral Tacrolimus in Patients with Moderate/Severe Ulcerative Colitis not Receiving Concomitant Corticosteroid Therapy

“…Thus far, several uncontrolled (9,14,15,17,19) and two placebo-controlled studies (13,18) have demonstrated that tacrolimus can induce remission in both adults (9, 13-15, 17, 18) and children (19). Another calcineurin inhibitor, CsA, is also highly active (60% to 80%) in patients with UC whose disease fails to respond to intravenous corticosteroid therapy (20). However, CsA has not been shown to improve long-term prognoses because it does not appear to be able to prevent relapse or colectomy once administration is stopped (6).…”

“…Moreover, CsA is known to be associated with many adverse effects, such as infections, renal dysfunction, hypertension and neurological toxicity (6). Although similar adverse events, including tremors, hyperglycemia, nephrotoxicity and infection, are observed in association with tacrolimus therapy, these effects are generally mild and reversible (19)(20)(21); thus, tacrolimus can be safely administered on a long-term basis. Yamamoto et al investigated the efficacy of tacrolimus as maintenance therapy for patients with refractory UC and suggested that the administration of tacrolimus with low trough levels (5 to 10 ng/mL) as maintenance therapy may represent an alternative therapy for UC patients (22).…”

The improving effects of Saengmaeksan on ulcerative colitis

“…However, the anti-colitis effect of SMS is not understood. UC is a chronic intestinal inflammation resulting in symptoms that include abdominal pain, weight loss and bloody diarrhea (Ardizzone and Bianchi, 2005;Rufo and Bousvaros, 2006;Sato et al, 2007).…”