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Thanks to a growing array of medications, techniques and therapies, most children with inflammatory bowel disease (IBD) are enjoying steadily improving quality of life. Yet not all patients are fully sharing these gains.
More work is needed to ensure that clinicians and families know about the latest, most effective therapies, says Dana Dykes, MD, a gastroenterologist at Cincinnati Children’s. With that goal in mind, Dykes discussed several trends in IBD treatment at the Family IBD Education Day, held March 2 in Mason, Ohio.
“We have a number of excellent medications to control IBD and even more-effective treatments showing promise in clinical trials,” she says. “As our tools and knowledge continue to improve, we see the potential for changing the natural history of these diseases.”
Many physicians follow a well-established treatment pyramid when trying to help children with IBD. The most commonly used tools at the base of the pyramid include nutritional therapy, antibiotics and the steroid budesonide (Entocort EC).
If these approaches are not effective, treatment escalates to a class of drugs that act directly against the immune system’s inflammatory response. These medications include methotrexate and 6-MP/azathioprine. Prednisone, a stronger steroid, also is commonly used at this stage.
Care for the hardest-to-control cases, at the tip of the pyramid, include four intensive approaches:
Currently, only three therapies achieve mucosal healing – the gold standard of IBD treatment. They are immunomodulators; nutritional therapy with exclusive enteral formula feeding; and infliximab (Remicade) and similar biologic agents.
Several new approaches that are not part of the traditional pyramid of care are being studied and some may eventually reach the market as safe and effective treatment options.
Dana Dykes, MD
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