Management of Paediatric Ulcerative Colitis, Part 2

Abstract

These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.

Immunotherapy for Inflammatory Bowel Disease

“…Рекомендована комбинация пероральных и местных препаратов 5-АСК, так как она более эффективна, чем применение каждого препарата в отдельности [35,36]. Важно использовать адекватные дозы препаратов 5-АСК при индукции и поддержании ремиссии ЯК.…”

“…Метотрексат угнетает дигидрофолатредуктазу и синтез ДНК, подавляет активность IL-1 и пролиферацию Т-лимфоцитов. Применение метотрексата при ЯК у детей в настоящее время не рекомендуется [35,36].…”

The impact of anti‐TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis—a nationwide study from 1995 to 2015

“…6 The introduction of anti-TNFα has added a relevant treatment option for paediatric and adolescent patients with UC. 7,8 Cohort studies and randomised controlled trials have shown that anti-TNFα therapy can induce and maintain remission in paediatric patients, but the studies are limited by a follow-up length of maximum 2 years. [7][8][9][10] Previously published studies on the effect of anti-TNFα therapy and the risk of surgery are not consistent, but the risk of surgery has been suggested reduced.…”

“…7,8 Cohort studies and randomised controlled trials have shown that anti-TNFα therapy can induce and maintain remission in paediatric patients, but the studies are limited by a follow-up length of maximum 2 years. [7][8][9][10] Previously published studies on the effect of anti-TNFα therapy and the risk of surgery are not consistent, but the risk of surgery has been suggested reduced. 11,12 Following the initiation of anti-TNFα therapy, a corticosteroid-free remission proportion of 38% has been reported among 52 paediatric patients with UC during a 1-year follow-up.…”

“…7,8 The guidelines recommend a step-up approach encompassing 5-aminosalicylates (5-ASA), corticosteroids, immunomodulators, anti-TNFα therapy, and colectomy in patients not responding to the medical treatment. 7,8 However, an early introduction of anti-TNFα therapy is also discussed as a corticosteroid sparring therapy paying special attention and consideration to the growth and development of the child. 14,15 Our first results have indicated a decline in the colectomy risk after the introduction of anti-TNFα.…”