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Diagnostic and Therapeutic Approach in Paediatric Inflammatory Bowel Diseases

Results from a Clinical Practice Survey

Bronsky, Jiri*; de Ridder, Lissy; Ruemmele, Frank M.; Griffiths, Anne§; Buderus, Stephan; Hradsky, Ondrej*; Hauer, Almuthe Christina||

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 676–683
doi: 10.1097/MPG.0000000000002233
Original Articles: Gastroenterology: Inflammatory Bowel Disease

Objectives: Despite existence of international guidelines for diagnosis and management of inflammatory bowel diseases (IBD) in children, there might be differences in the clinical approach.

Methods: A survey on clinical practice in paediatric IBD was performed among members of the ESPGHAN Porto IBD working group and interest group, PIBD-NET, and IBD networks in Canada and German-speaking countries (CIDsCANN, GPGE), using a web-based questionnaire. Responses to 63 questions from 106 paediatric IBD centres were collected.

Results: Eighty-four percentage of centres reported to fulfil the revised Porto criteria in the majority of patients. In luminal Crohn disease (CD), exclusive enteral nutrition is used as a first-line induction therapy and immunomodulators (IMM) are used since diagnosis in the majority of patients. Infliximab (IFX) is mostly considered as first-line biological. Sixty percentage of centres have experience with vedolizumab and/or ustekinumab and 40% use biosimilars. In the majority of ulcerative colitis (UC) patients 5-aminosalicylates are continued as concomitant therapy to IMM (usually azathioprine [AZA]/6-MP). After ileocaecal resection (ICR) in CD patients without postoperative residual disease, AZA monotherapy is the preferred treatment.

Conclusions: A majority of centres follows both the Porto diagnostic criteria as well as paediatric (ESPGHAN/ECCO) guidelines on medical and surgical IBD management. This reflects the value of international societal guidelines. However, potentially desirable answers might have been given instead of what is true daily practice, and the most highly motivated people might have answered, leading to some bias.

*Department of Paediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic

Department of Paediatric Gastroenterology, The Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands

Department of Paediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France

§Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Department of Paediatrics, St. Marien Hospital, Bonn, Germany

||GPGE-Educational Center for Paediatric Gastroenterology, Department of Paediatrics, Medical University of Graz, Graz, Austria.

Address correspondence and reprint requests to Jiri Bronsky, MD, PhD, Associate Professor of Paediatrics, Gastroenterology and Nutrition Unit, Department of Paediatrics, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic (e-mail:

Received 30 August, 2018

Accepted 23 November, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Conference presentation: Preliminary data were presented as an abstract at the ESPGHAN Annual Meeting, Prague, Czech Republic, May, 2017 (poster No. G-P-240; abstract no. 1232).

J.B. reports personal fees and non-financial support from AbbVie, Nutricia, Biocodex, personal fees from MSD, Nestlé, Ferring, Walmark, outside the submitted work. L.d.R. reports other from Malinckrodt, Nestle, Celltrion, and Abbvie, outside the submitted work. F.R. reports grants from AbbVIE and Nestlé Health Science, personal fees from AbbVie, Jansen, Celegene, Pfizer, Nestlé Health science, and Nestlé Nutrition Institute, outside the submitted work. A.G. reports grants and personal fees from Abbvie, personal fees from Janssen, Roche, Gilead, Pfizer, Celgene, Lily and Shire, outside the submitted work. S.B. reports personal fees from Infectopharm, Abbvie, Nutricia, Nestlé Nutrition Institute and Ferring, outside the submitted work. O.H. reports personal fees from Abbvie, MSD, Nestlé, Nutricia, Ferring and Falk, outside the submitted work. A.C.H. reports personal fees from AbbVie, MSD, and Nutricia, grants from Chaudoire-Science-Support, outside the submitted work.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,