Consensus and Controversy in the Management of Pediatric Crohn's Disease: An International Survey – מתוך כנס גאסטרו ילידים, 9 ביולי 2002


Arie Levine M.D1, Tamir Milo MD1, Hans Buller M.D2,James Markowitz M.D3

Pediatric Gastroenterology Unit, E.Wolfson Medical Center , Holon,Israel1, Sophia Children's Hospital, Rotterdam, The Netherlands2, North Shore University Hospital, Manhasset, New York, USA3

Background: Treatment options for Crohn's disease (CD) have expanded, but the use in clinical practice of some of these options remain controversial We therefore attempted to evaluate current trends in treatment, and assess areas of consensus or controversy.

Methods: An international survey of certified pediatric gastroenterologists by e-mail questionnaire, which attempted to evaluate the treatment of active disease, attitudes towards four types of therapy, and role of testing for osteopenia and 6 thioguanine levels.

Results: 167 physicians from the USA, Canada, Western Europe, and Israel were included. The majority of North American physicians (71%) prefer use of conventional steroids and AZA before nutritional therapy or budesonide in mild to moderate active disease, versus 21% of Western Europeans (p<0.001). West Europeans prefer nutritional therapy followed by budesonide or steroids for non severe disease. Only 4% of North American gastroenterologists use nutritional therapy frequently, versus 62% of their West European colleagues (p<0.001). Infliximab was thought to be effective in steroid unresponsive disease by almost all physicians surveyed, though its efficacy as a maintenance therapy was rated higher by North American physicians in comparison to European or Israeli colleagues (p<0.01). Bone mineral density is routinely evaluated by about 45% of physicians in Europe and North America.

Conclusions: Attitudes toward current therapies influence how patients are managed, and vary significantly by region, with North Americans strongly favoring corticosteroids followed by immunomodulatory therapy, and Europeans favoring nutritional therapy or budesonide and the avoidance of conventional corticosteroids.

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