Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. May 15, 2015; 6(2): 33-42
Published online May 15, 2015. doi: 10.4291/wjgp.v6.i2.33
Current therapy of pediatric Crohn’s disease
Avishay Lahad, Batia Weiss
Avishay Lahad, Batia Weiss, Pediatric Gastroenterology, Hepatology and Nutrition Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer 52661, Israel
Avishay Lahad, Batia Weiss, Tel-Aviv University, Tel-Aviv 69978, Israel
Author contributions: Lahad A and Weiss B wrote the paper.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Avishay Lahad, MD, Pediatric Gastroenterology, Hepatology and Nutrition Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Tel Hashomer 52661, Israel.
Telephone: +972-3-5305006 Fax: +972-3-5302883
Received: July 24, 2014
Peer-review started: July 24, 2014
First decision: August 15, 2014
Revised: November 3, 2014
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: May 15, 2015

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis, are chronic relapsing and remitting diseases of the bowel, with an unknown etiology and appear to involve interaction between genetic susceptibility, environmental factors and the immune system. Although our knowledge and understanding of the pathogenesis and causes of IBD have improved significantly, the incidence in the pediatric population is still rising. In the last decade more drugs and treatment option have become available including 5-aminosalicylate, antibiotics, corticosteroids, immunomodulators and biological agents. Before the use of anti-tumor necrosis factor (TNF)-α became available to patients with IBD, the risk for surgery within five years of diagnosis was very high, however, with anti-TNF-α treatment the risk of surgery has decreased significantly. In the pediatric population a remission in disease can be achieved by exclusive enteral nutrition. Exclusive enteral nutrition also has an important role in the improvement of nutritional status and maintained growth. In this review we summarize the current therapeutic treatments in CD. The progress in the treatment options and the development of new drugs has led to optimized tactics for achieving the primary clinical goals of therapy - induction and maintenance of remission while improving the patient’s growth and overall well-being.

Keywords: Pediatric Crohn’s disease, Immunomodulators, Antibiotics, Nutrition, Anti-tumor necrosis factor, Steroids, 5-aminosalicylic acid

Core tip: Inflammatory bowel diseases are chronic relapsing diseases of the bowel, with an unknown etiology, rising incidence in the pediatric population, and increasing therapeutic options. The therapeutic goal has changed over the last decade towards accelerated step up or top down therapy with a goal of achieving mucosal healing and perhaps changing the disease course. In this review we discuss these therapeutic approaches.