Surgery in Pediatric Crohn's Disease: Indications, Timing and Post-Operative Management

Kim, Seung

doi:10.5223/pghn.2017.20.1.14

Cited by 28 publications

(25 citation statements)

References 47 publications

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“…9,38 Also, the median time to operation in the pediatric population is significantly shorter than in adults. 18,39 Among patients affected by CD, those with early-onset disease are shown to have a much more extensive disease involvement than adult-onset IBD. 40 However, fewer patients in the early-onset group require surgery compared with adultonset CD patients.…”

Section: Differences Between Early and Late Onset Ibdmentioning

confidence: 99%

Early onset inflammatory bowel disease: manifestations, genetics and diagnosis

Moazzami¹,

Moazzami²,

Rezaei³

2019

Turk J Pediatr

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Crohn's disease and ulcerative colitis are immunologically mediated chronic inflammatory conditions, collectively referred to as inflammatory bowel diseases (IBD). While most studies have described the condition in the adult population, recent evidences suggest that IBD in children may represent an etiologically distinct disease from the adult onset IBD. Since a significant proportion of patients diagnosed with IBD demonstrate their clinical manifestations during childhood, knowledge about the disease progression, severity and diagnosis in this particular patient population is crucial. Therefore, in the present study, the clinical manifestations, recent advancements in the genetics of early onset IBD and the clinical approach to diagnoses of IBD in children are described.

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Section: Differences Between Early and Late Onset Ibdmentioning

confidence: 99%

Early onset inflammatory bowel disease: manifestations, genetics and diagnosis

Moazzami¹,

Moazzami²,

Rezaei³

2019

Turk J Pediatr

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“…The disease course is usually progressive, and half of affected patients are known to experience complications such as strictures and fistulas, leading to persisting and refractory symptoms, impaired quality of life, and surgery [ 2 3 ]. It is known that approximately 25% of CD cases develop during childhood or adolescence, and pediatric CD is more progressive and extensive than CD that occurs in adults [ 4 5 ]. Another unique feature of pediatric CD compared with adult-onset CD is linear growth impairment, which is more profound in patients who have undergone a prolonged period of active disease [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Early Biologic Treatment in Pediatric Crohn's Disease: Catching the Therapeutic Window of Opportunity in Early Disease by Treat-to-Target

Kang

Choe

2018

Pediatr Gastroenterol Hepatol Nutr

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The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn's disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn's disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increasing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up process by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn's disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive discussion with each patient and guardian.

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“…Inflammatory bowel disease (IBD), which consists of Crohn disease (CD) and ulcerative colitis (UC), is a chronic relapsing disease that can negatively affect a patient's QoL . The incidence of IBD is increasing rapidly worldwide, and up to 25% of patients are diagnosed during childhood or adolescence . As with other chronic illnesses, it is essential to assess QoL to improve patient outcomes .…”

Section: Introductionmentioning

confidence: 99%