Richtlijn 'Diagnostiek en behandeling van inflammatoire darmziekte bij kinderen'
Guideline 'Diagnosis and treatment of inflammatory bowel disease in children'.
Nederlands Tijdschrift voor Geneeskunde , Volume 154
A multidisciplinary working group has outlined evidence-based practice guidelines for the diagnosis and treatment of inflammatory bowel disease in children (IBD). Both diagnosis and treatment of IBD in children differ significantly from practice in adults. The incidence of IBD in children is low (5.2 per 100,000 per year in the age group 0-17 years), but most of the presenting symptoms are non-specific; therefore it is difficult for the general practitioner to recognise the disease in children. For a correct diagnosis, ileocolonoscopy and upper gastrointestinal endoscopy are necessary, often combined with radiological imaging of the small bowel. In children and adolescents with Crohn's disease, nutritional therapy is the first choice of treatment for remission induction. As maintenance treatment, immunomodulators (azathioprine or mercaptopurine) should be started from the time of initial diagnosis. In children and adolescents with ulcerative colitis, the first treatment is with aminosalicylates. Prednisone and/or immunomodulators (azathioprine, cyclosporin) are indicated if there is insufficient response to aminosalicylates. A final treatment option is colectomy. The transition from paediatric to adult health care needs special attention as the patient and his or her parents may be reluctant to change trusted contacts which they have made.