Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease.

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Abstract

We aim to provide guidance for medical treatment of luminal Crohn's disease in children.

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Most cited references 156

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Ustekinumab induction and maintenance therapy in refractory Crohn's disease.

William J Sandborn, Christopher Gasink, Long-Long Gao … (2012)

In patients with Crohn's disease, the efficacy of ustekinumab, a human monoclonal antibody against interleukin-12 and interleukin-23, is unknown. We evaluated ustekinumab in adults with moderate-to-severe Crohn's disease that was resistant to anti-tumor necrosis factor (TNF) treatment. During induction, 526 patients were randomly assigned to receive intravenous ustekinumab (at a dose of 1, 3, or 6 mg per kilogram of body weight) or placebo at week 0. During the maintenance phase, 145 patients who had a response to ustekinumab at 6 weeks underwent a second randomization to receive subcutaneous injections of ustekinumab (90 mg) or placebo at weeks 8 and 16. The primary end point was a clinical response at 6 weeks. The proportions of patients who reached the primary end point were 36.6%, 34.1%, and 39.7% for 1, 3, and 6 mg of ustekinumab per kilogram, respectively, as compared with 23.5% for placebo (P=0.005 for the comparison with the 6-mg group). The rate of clinical remission with the 6-mg dose did not differ significantly from the rate with placebo at 6 weeks. Maintenance therapy with ustekinumab, as compared with placebo, resulted in significantly increased rates of clinical remission (41.7% vs. 27.4%, P=0.03) and response (69.4% vs. 42.5%, P<0.001) at 22 weeks. Serious infections occurred in 7 patients (6 receiving ustekinumab) during induction and 11 patients (4 receiving ustekinumab) during maintenance. Basal-cell carcinoma developed in 1 patient receiving ustekinumab. Patients with moderate-to-severe Crohn's disease that was resistant to TNF antagonists had an increased rate of response to induction with ustekinumab, as compared with placebo. Patients with an initial response to ustekinumab had significantly increased rates of response and remission with ustekinumab as maintenance therapy. (Funded by Janssen Research and Development; CERTIFI ClinicalTrials.gov number, NCT00771667.).

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The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults.

Carlo A Fallone, Naoki Chiba, Sander van Zanten … (2016)

Helicobacter pylori infection is increasingly difficult to treat. The purpose of these consensus statements is to provide a review of the literature and specific, updated recommendations for eradication therapy in adults.

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Mucosal healing in inflammatory bowel diseases: a systematic review.

Markus F. Neurath, Simon P L Travis (2012)

Recent studies have identified mucosal healing on endoscopy as a key prognostic parameter in the management of inflammatory bowel diseases (IBD), thus highlighting the role of endoscopy for monitoring of disease activity in IBD. In fact, mucosal healing has emerged as a key treatment goal in IBD that predicts sustained clinical remission and resection-free survival of patients. The structural basis of mucosal healing is an intact barrier function of the gut epithelium that prevents translocation of commensal bacteria into the mucosa and submucosa with subsequent immune cell activation. Thus, mucosal healing should be considered as an initial event in the suppression of inflammation of deeper layers of the bowel wall, rather than as a sign of complete healing of gut inflammation. In this systematic review, the clinical studies on mucosal healing are summarised and the effects of anti-inflammatory or immunosuppressive drugs such as 5-aminosalicylates, corticosteroids, azathioprine, ciclosporin and anti-TNF antibodies (adalimumab, certolizumab pegol, infliximab) on mucosal healing are discussed. Finally, the implications of mucosal healing for subsequent clinical management in patients with IBD are highlighted.

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Author and article information

Journal

Journal ID (iso-abbrev): J Can Assoc Gastroenterol

Title: Journal of the Canadian Association of Gastroenterology

Publisher: Oxford University Press (OUP)

ISSN (Electronic): 2515-2092

ISSN (Print): 2515-2084

Publication date (Electronic): Aug 2019

Volume: 2

Issue: 3

Affiliations

[1 ] Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

[2 ] Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.

[3 ] Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada.

[4 ] School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.

[5 ] Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada.

[6 ] Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.

[7 ] Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

[8 ] IBD Centre, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada.

[9 ] Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire, Sainte-Justine, Montréal, Quebec, Canada.

[10 ] Section of Pediatric Gastroenterology, Department of Pediatrics, Health Sciences Centre, Winnipeg, Manitoba, Canada.

[11 ] Department of Pediatrics (Gastroenterology), Stollery Children's Hospital, Edmonton, Alberta, Canada.

[12 ] Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.

[13 ] Division of Gastroenterology and Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada.

[14 ] Division of Pediatric Gastroenterology, McMaster University, Hamilton, Ontario, Canada.

[15 ] Division of Pediatric Gastroenterology, University of North Carolina, Hospital-Children's Specialty Clinic, Chapel Hill, North Carolina.

[16 ] Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, Alberta, Canada.

Article

Publisher Item ID: gwz018

DOI: 10.1093/jcag/gwz018

PMC ID: 6619414

PubMed ID: 31294379

SO-VID: 72893099-f28b-4282-8e34-2a00785d4ede

History

Keywords: GRADE,IBD,Inflammatory Bowel Diseases,TNF

Data availability:

Keywords: GRADE, IBD, Inflammatory Bowel Diseases, TNF

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Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease.

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Abstract

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Karger: Gastroenterology

Most cited references 156

Ustekinumab induction and maintenance therapy in refractory Crohn's disease.

The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults.

Mucosal healing in inflammatory bowel diseases: a systematic review.

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Cited by 9