Crohns_Disease_Flashcards
Q
A
What are the gold-standard guidelines for paediatric Crohn’s Disease management?
ECCO-ESPGHAN guidelines (2020).
How should children be risk stratified at diagnosis?
Using the Paris classification into low, medium, or high risk.
What criteria are used to risk-stratify children with Crohn’s Disease?
Predictors of poor disease outcomes identified at endoscopy.
What characterizes low-risk children in Crohn’s Disease?
Children with purely inflammatory disease, with no strictures or penetrating disease.
What characterizes medium-risk children in Crohn’s Disease?
Low-risk children with no sign of clinical or biochemical remission 12 weeks after initial treatment, children with growth delay.
What characterizes high-risk children in Crohn’s Disease?
Children with stricturing or penetrating disease, or any additional risk factors (e.g. growth delay, extensive disease, deep ulceration, perianal disease).
What is the first-line treatment for high-risk children with Crohn’s Disease?
Anti-TNF therapy (e.g. infliximab).
What combination might be considered with anti-TNF therapy for high-risk children?
Combination with immunomodulation (e.g. methotrexate).
What is the maintenance therapy if anti-TNF induction treatment is effective in high-risk children?
Maintenance anti-TNF monotherapy.
What should be done if induction treatment is ineffective in high-risk children?
Optimize anti-TNF therapy, add immunomodulator (e.g. methotrexate), consider increasing dosage or frequency of anti-TNF therapy, or switch anti-TNF agent (e.g. to adalimumab).
What is the first-line treatment for low-risk children with Crohn’s Disease?
Exclusive enteral nutrition (EEN) for 12 weeks.
What may be considered if EEN is not an option for low-risk children?
Corticosteroids.
What is the maintenance therapy if EEN or corticosteroids are effective in low-risk children?
Maintenance therapy with methotrexate or thiopurine, with escalation to anti-TNF therapy if needed.
What should be done if first-line treatment is not effective at inducing remission in low-risk children?
Step-up early to anti-TNF therapy with immunomodulation.
What methods can be used for disease activity monitoring in Crohn’s Disease?
Biochemical: Faecal calprotectin (with CRP) or trough concentration levels of anti-TNF agents; Clinical: Paediatric Crohn’s Disease Activity Index; Imaging: MRI small-bowel or endoscopy.
What recent trials informed the shift in guidelines to start anti-TNF agents as first-line treatment in Crohn’s Disease?
TISKIDS and REACH trials.
What is the most accurate measure of dehydration in Crohn’s Disease?
The degree of weight loss during the illness.
What indicates clinical dehydration and shock in terms of percentage weight loss?
Clinical dehydration: ≥ 5%; Shock: > 10%.
What is the mainstay of therapy for clinical dehydration in Crohn’s Disease?
Oral rehydration solution, 75 mL/kg every 4 hours.
When are IV fluids indicated for Crohn’s Disease?
For shock, deterioration, or persistent vomiting.
What are the key points to explain to parents about Crohn’s Disease?
It is a disease with an unknown cause that causes inflammation of the digestive system leading to malabsorption and bloody diarrhoea, it is a life-long condition with a risk of relapse, there are many medications available to manage flare-ups, complications include malabsorption and bowel cancer, there is no special diet but certain foods may exacerbate symptoms.
What support group is recommended for Crohn’s Disease?
Crohn’s and Colitis UK.
