OBJECTIVE: We aimed to provide an evidence-supported update of the ECCO-ESPGHAN guideline on the medical management of paediatric Crohn's disease [CD]. METHODS: We formed 10 working groups and formulated 17 PICO-structured clinical questions [Patients, Intervention, Comparator, and Outcome]. A systematic literature search from January 1, 1991 to March 19, 2019 was conducted by a medical librarian using MEDLINE, EMBASE, and Cochrane Central databases. A shortlist of 30 provisional statements were further refined during a consensus meeting in Barcelona in October 2019 and subjected to a vote. In total 22 statements reached ≥ 80% agreement and were retained. RESULTS: We established that it was key to identify patients at high risk of a complicated disease course at the earliest opportunity, to reduce bowel damage. Patients with perianal disease, stricturing or penetrating behaviour, or severe growth retardation should be considered for up-front anti-tumour necrosis factor [TNF] agents in combination with an immunomodulator. Therapeutic drug monitoring to guide treatment changes is recommended over empirically escalating anti-TNF dose or switching therapies. Patients with low-risk luminal CD should be induced with exclusive enteral nutrition [EEN], or with corticosteroids when EEN is not an option, and require immunomodulator-based maintenance therapy. Favourable outcomes rely on close monitoring of treatment response, with timely adjustments in therapy when treatment targets are not met. Serial faecal calprotectin measurements or small bowel imaging [ultrasound or magnetic resonance enterography] are more reliable markers of treatment response than clinical scores alone. CONCLUSIONS: We present state-of-the-art guidance on the medical treatment and long-term management of children and adolescents with CD.

Assistance Publique Hôpitaux de Paris Hôpital Necker Enfants Malades Pediatric Gastroenterology Paris France

Child Life and Health University Of Edinburgh Edinburgh UK

Department of Biomedical Sciences Humanitas University Pieve Emanuele Milan Italy

Department of Colon and Rectal Surgery Humanitas Clinical and Research Center IRCCS Rozzano Milano Italy

Department of Gastroenterology Nutrition and Liver Diseases Schneider Children's Medical Center Petach Tikvah Affiliated to the Sackler Faculty of Medicine Tel Aviv University Israel

Department of Paediatric Gastroenterology and Nutrition Royal Hospital for Sick Children Edinburgh UK

Department of Paediatric Gastroenterology Barts Health Trust The Royal London Children's Hospital London UK

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

Department of Paediatric Gastroenterology University of Groningen University Medical Centre Groningen Beatrix Children's Hospital Groningen The Netherlands

Department of Paediatrics Children´s Hospital University of Helsinki and Tampere University Tampere Finland

Department of Paediatrics Division of Gastroenterology Hepatology and Nutrition Hospital for Sick Children University of Toronto Toronto Canada

Department of Pediatric Gastroenterology Hepatology and Nutrition Hospital Sant Joan de Déu Barcelona Spain

Department of Pediatrics Centre for Clinical Research Västmanland Hospital Västeras and Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden

Department of Pediatrics Division of Gastroenterology and Hepatology Dr von Hauner Children's Hospital University Hospital LMU Munich Munich Germany

Department of Pediatrics Gastroenterology and Nutrition School of Medicine Collegium Medicum University of Warmia and Mazury Olsztyn Poland

Division of Pediatric Gastroenterology and Nutrition Amsterdam UMC location AMC Amsterdam The Netherlands

Division of Pediatric Gastroenterology Edmonton Pediatric IBD Clinic Departments of Pediatrics and Physiology University of Alberta Edmonton Canada

Faculté de Médecine Université Sorbonne Paris Cité Paris Descartes Paris France

Human Nutrition School of Medicine Dentistry and Nursing University of Glasgow Glasgow UK

Paediatric Gastroenterology Shaare Zedek Medical Centre the Hebrew University of Jerusalem Israel

Paediatric Gastroenterology Unit Department of Paediatrics University Hospital Motol Prague Czech Republic

Pediatric Gastroenterology and Liver Unit Maternal and Child Health Department Sapienza University of Rome Rome Italy

Pediatric Gastroenterology and Nutrition Unit IBIMA Hospital Regional Universitario de Málaga Málaga Spain

Pediatric Gastroenterology and Nutrition Unit Wolfson Medical Center Tel Aviv University Israel

Pediatric Gastroenterology Unit Edmond and Lily Safra Children's Hospital Sheba Medical Center Ramat Gan Israel

Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

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