The Principles of Drug Therapy of Crohn's Disease in Child and Adolescent

Abstract

Crohn’s disease (CD) is a chronic, relapsing disorder of unknown etiology and which affects patients for their entire life. Pediatric CD is significant in that approximately 25% of inflammatory bowel disease (IBD) patients are diagnosed as children and adolescents. The incidence continues to rise rapidly, but has not yet plateaued in Korea. The other important issues of pediatric CD are growth impairment and pubertal delay, both of which may result in permanent problems and which should be considered as one of the important aspects of treatment in contrast to that seen in adult patients. This review article presents pediatric clinicians with the basic principles of the medical treatment of Crohn’s disease as it presents in childhood and adolescence. The goal of treatment in pediatric Crohn’s disease is to achieve physical and psychological remission which includes freedom from abdominal pain, hematochezia, anemia, luminal inflammation, maintaining the normal value of albumin and inflammatory markers, stopping the use of corticosteroids, achieving normal growth and puberty, and also maintaining optimal mental health. We extensively reviewed the current studies in addition to conventional treatments which include 5-ASA, nutritional therapy, antibiotics, immunosuppressants, and anti-TNF-alpha blockades. We also attempted to consider the specific treatment of luminal and fistulizing disease, management in postoperative situations, and the optimal management strategy in order to maintain normal physical growth. [Korean J Pediatr Gastroenterol Nutr 2010; 13(Suppl 1): 59∼69]