Crohn's disease in children and adolescents: What are the treatment options?

The unique challenge and responsibility of managing Crohn's disease in a ch ild, in comparison to an adult, is to employ pharmacologic, nutritional, an d where appropriate, surgical interventions not only to control intestinal inflammation, but also to optimize growth and facilitate normal pubertal an d social development. Growth can be considered an important marker of contr ol of disease activity and success of therapy. There are two major factors contributing to the frequently observed impairment of linear growth: 1) chr onic undernutrition related primarily to inadequate intake, and 2) the now better elucidated direct effects of inflammatory cytokines produced by the diseased intestine. Therefore, reduction of intestinal inflammation and pro vision of adequate nutrition are of paramount importance in optimizing line ar growth. These goals are currently best achieved through judicious use of corticosteroids, employment of immune modulating drugs, often through prov ision of enteral nutrition using formulated food, and not infrequently thro ugh timely referral for resection of localized, stenotic disease. As in adu lts, the selection of therapy is guided by knowledge of the site and nature of intestinal inflammation.