Authors
Dror S Shouval, Iva Hojsak, Erasmo Miele, Christiane Sokollik, Dan Turner, Kaija-Leena Kolho, Rotem Sigall-Boneh, Patrick F van Rheenen, Eytan Wine, Richard K Russell, Seamus Hussey, Neil Chanchlani, Amit Assa, Javier Martin de Carpi, Luca Scarallo, Anne M Griffiths, Anat Yerushalmy-Feler, Caterina Strisciuglio, Lissy de Ridder, Jiri Bronsky, Hannah Gordon, Michel Adamina, Johanna C Escher, Marco Gasparetto, Laura Gianolio, David C Wilson, Marina Aloi
Published in
Journal of Crohn's & colitis. Volume 20. Issue 8. Aug 05, 2026.
Abstract
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].
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.
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.
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.
PMID:
42618885
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.
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