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Shouval, Dror S., Hojsak, Iva, Miele, Erasmo, Sokollik, Christiane, Turner, Dan, Kolho, Kaija-Leena, Sigall-Boneh, Rotem, van Rheenen, Patrick F., Wine, Eytan, Russell, Richard K., Hussey, Séamus, Chanchlani, Neil, Assa, Amit, Martín de Carpi, Javier, Scarallo, Luca, Griffiths, Anne M., Yerushalmy-Feler, Anat, Strisciuglio, Caterina, de Ridder, Lissy, Bronsky, Jiri, Gordon, Hannah, Adamina, Michel, Escher, Johanna C., Gasparetto, Marco 
ORCID: https://orcid.org/0000-0002-3882-3606, Gianolio, Laura, Wilson, David C. and Aloi, Marina
(2026)
Management of pediatric Crohn's disease: an ECCO-ESPGHAN guideline update.
Journal of Crohn's & Colitis, 20 (8).
ISSN 1873-9946
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Abstract
Objective: To provide an updated, evidence-based European Crohn's and Colitis Organisation [ECCO]-European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] guideline for the management, monitoring, and long-term care of pediatric Crohn's disease [CD]. Methods: A multidisciplinary panel of 27 experts followed ECCO Standard Operating Procedures for guideline development. A systematic review of studies published between January 2018 and October 2024, with targeted updates through June 2025, was conducted across MEDLINE, EMBASE, and Cochrane Central. Evidence was graded using the Oxford Centre for Evidence-Based Medicine levels. Draft statements underwent two Delphi voting rounds involving the guideline panel, ECCO National Representatives, and an international sounding board; statements achieving ≥80% agreement were accepted. Results: This guideline provides updated recommendations across major domains of pediatric CD care, including risk stratification, treatment targets, induction and maintenance strategies, nutritional therapies, therapeutic drug monitoring, and the roles of imaging and endoscopy. High-risk patients should start anti-TNF therapy as first-line treatment, with proactive and reactive therapeutic drug monitoring to enhance efficacy. For low-risk luminal disease, exclusive enteral nutrition or the Crohn's Disease Exclusion Diet with partial enteral nutrition are preferred induction options. Long-term management emphasizes achieving endoscopic remission, normal growth, improved quality of life, and reduction of bowel damage. This guideline also reviews emerging advanced therapies, including biologics and small molecules, which are increasingly used in practice but generally not yet approved for pediatric CD, to inform clinicians about their potential role. Conclusions: This updated ECCO-ESPGHAN guideline integrates new pediatric evidence with contemporary adult data and treat-to-target principles, providing practical recommendations to support personalized, multidisciplinary, and proactive management aimed at improving long-term outcomes in pediatric CD.
| Item Type: | Article |
|---|---|
| Additional Information: | Publisher Copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) |
| Uncontrolled Keywords: | therapeutic drug monitoring,gastroenterology ,/dk/atira/pure/subjectarea/asjc/2700/2715 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 04 Sep 2026 12:32 |
| Last Modified: | 07 Sep 2026 16:13 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/104425 |
| DOI: | 10.1093/ecco-jcc/jjag084 |
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