tailieunhanh - Treatment of Inflammatory Bowel Disease in Childhood: Best Available Evidence

The most common identifiable cause of ACS in this study was pulmonary fat embolism (PFE). 4 Originally described in trauma victims, PFE is a frequent complication of bone fracture and may progress to involve the lungs and CNS with multiorgan failure and death. 10,11 The NACSS made the diagnosis by using BAL to identify fat-laden macrophages; less-invasive means of making the diagnosis are not well established, and even the specificity of fat-laden macrophages in BAL specimens has been questioned. 12 Vichinsky et al, 13 in the first systematic, prospective search for PFE in sickle cell disease, found that 44% of patients with moderate-to- severe ACS had PFE as a probable etiology. These patients had longer,. | Inflammatory Bowel Diseases 9 1 34-58 2003 Crohn s Colitis Foundation of America Inc. Clinical Review Treatment of Inflammatory Bowel Disease in Childhood Best Available Evidence fJohanna C. Escher Jan A. J. M. Taminiau fEdward E. S. Nieuwenhuis Hans A. Buller and fRichard J. Grand Department of Pediatric Gastroenterology Emma Children s Hospital Academic Medical Center University of Amsterdam The Netherlands Center for Inflammatory Bowel Disease Division of Gastroenterology and Nutrition The Children s Hospital Boston Massachusetts . ịGastroenterology Division Brigham and Women s Hospital Harvard Medical School Boston Massachusetts . and Department of Pediatrics Sophia Children s Hospital Erasmus University of Rotterdam The Netherlands. Summary The physician treating children with inflammatory bowel disease is confronted with a number of specific problems one of them being the lack of randomized controlled drug trials in children. In this review the role of nutritional therapy is discussed with a focus on primary treatment especially for children with Crohn s disease. Then the available medical therapies are highlighted reviewing the evidence of effectiveness and side effects in children as compared with what is known in adults. Nutritional therapy has proven to be effective in inducing and maintaining remission in Crohn s disease while promoting linear growth. Conventional treatment consists of aminosalicylates and corticosteroids whereas the early introduction of immunosuppressives such as azathio prine or 6-mercaptopurine is advocated as maintenance treatment. If these drugs are not tolerated or are ineffective methotrexate may serve as an alternative in Crohn s disease. Cyclosporine is an effective rescue therapy in severe ulcerative colitis but only will postpone surgery. A novel strategy to treat Crohn s disease is offered by infliximab a monoclonal antibody to the proinflammatory cytokine tumor necrosis factor TNF -a. Based on the best-available .