A gyulladásos bélbetegség (IBD) a bélrendszer krónikus gyulladása, melynek hátterében feltételezik a megváltozott bélflórára adott kóros autoimmun választ a szervezet részéről. Mint a legtöbb autoimmun kórkép, multifaktoriálisnak tekinthető, mind a mai napig nem ismerünk egyetlen kiváltó okot, sem pontos genetikai hátteret, sem olyan általános jellemző immunológiai eltérést, amellyel biztosan azonosítható a kórkép. Ami egyértelműen hozzájárulhat a betegség kialakulásához, az a környezeti hatások közül az étkezéssel összefüggő káros anyagok bevitele. Ezt támasztja alá az IBD gyermekkorban leggyakrabban előforduló fajtájának, a Crohn-betegségnek a kezelési stratégiája, amely kezdetben szigorú diétából áll. Ám a Crohn-betegségben és az IBD másik fajtájában, a colitis ulcerosában is egyre gyakrabban van szükség az általános immunszuppresszió mellett, főleg gyermekkorban, az ún. biológiai terápiákra, amelyek célzottan gátolják a gyulladásos mechanizmusokat. A biológiai terápia lehetőséget ad a számos mellékhatással bíró szteroid-, sőt akár az általános immunszuppresszív kezeléssel való spórolásra, és bélmentő eljárásként a sebészeti eltávolítás szükségességét is csökkenti. A kezelésben ma már hazánkban is elérhető terápiás gyógyszerszint- és ellenanyagszint-monitorizálás segítségével proaktívan, tehát már a tünetek kialakulása előtt be lehet avatkozni a kezelés optimalizálásába a jobb életminőség eléréséhez. Orv Hetil. 2023; 164(25): 963–970.
Van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn’s disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis 2021; 15: 171–194.
Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis. Part 1: Ambulatory care – An evidence-based guideline from European Crohn’s and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018; 67: 257–291.
Ricciuto A, Aardoom M, Orlanski-Meyer E, et al. Predicting outcomes in pediatric Crohn’s disease for management optimization: systematic review and consensus statements from the Pediatric Inflammatory Bowel Disease-Ahead Program. Gastroenterology 2021; 160: 403–436.e26.
Orlanski-Meyer E, Aardoom M, Ricciuto A, et al. Predicting outcomes in pediatric ulcerative colitis for management optimization: systematic review and consensus statements from the Pediatric Inflammatory Bowel Disease-Ahead Program. Gastroenterology 2021; 160: 378–402.e22.
Uhlig HH, Charbit-Henrion F, Kotlarz D, et al. Clinical genomics for the diagnosis of monogenic forms of inflammatory bowel disease: a position paper from the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2021; 72: 456–473.
Reinglas J, Gonczi L, Kurt Z, et al. Positioning of old and new biologicals and small molecules in the treatment of inflammatory bowel diseases. World J Gastroenterol. 2018; 24: 3567–3582.
Abegunde AT, Muhammad BH, Bhatti O, et al. Environmental risk factors for inflammatory bowel diseases: evidence based literature review. World J Gastroenterol. 2016; 22: 6296–6317.
Ananthakrishnan AN, Bernstein CN, Iliopoulos D, et al. Environmental triggers in IBD: a review of progress and evidence. Nat Rev Gastroenterol Hepatol. 2018; 15: 39–49.
Nishida A, Inoue R, Inatomi O, et al. Gut microbiota in the pathogenesis of inflammatory bowel disease. Clin J Gastroenterol. 2018; 11: 1–10.
Brzozowski B, Mazur-Bialy A, Pajdo R. Mechanisms by which stress affects the experimental and clinical inflammatory bowel disease (IBD): role of brain–gut axis. Curr Neuropharmacol. 2016; 14: 892–900.
Franzosa EA, Sirota-Madi A, Avila-Pacheco J, et al. Gut microbiome structure and metabolic activity in inflammatory bowel disease. Nat Microbiol. 2019; 4: 293–305. Erratum: Nat Microbiol. 2019; 4: 898.
Sigall-Boneh R, Pfeffer-Gik T, Segal I, et al. Partial enteral nutrition with a Crohn’s disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease. Inflamm Bowel Dis. 2014; 20: 1353–1360.
Levine A, Wine E, Assa A, et al. Crohn’s disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology 2019; 157: 440–450.e8.
Jiang Y, Jarr K, Layton C, et al. Therapeutic implications of diet in inflammatory bowel disease and related immune-mediated inflammatory diseases. Nutrients 2021; 13: 890.
Sarbagili Shabat C, Scaldaferri F, Zittan E, et al. Use of faecal transplantation with a novel diet for mild to moderate active ulcerative colitis. The CRAFT UC randomised controlled trial. J Crohns Colitis 2022; 16: 369–378.
Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis. Part 2: Acute severe colitis – An evidence-based consensus guideline from the European Crohn’s and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018; 67: 292–310.
Corica D, Romano C. Biological therapy in pediatric inflammatory bowel disease: a systematic review. J Clin Gastroenterol. 2017; 51: 100–110.
De Ridder L, Assa A, Bronsky J, et al. Use of biosimilars in paediatric inflammatory bowel disease: an updated position statement of the Paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2019; 68: 144–153.
Hyams J, Crandall W, Kugathasan S, et al. Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn’s disease in children. Gastroenterology 2007; 132: 863–873.
Rosh JR, Lerer T, Markowitz J, et al. Retrospective evaluation of the safety and effect of adalimumab therapy (RESEAT) in pediatric Crohn’s disease. Am J Gastroenterol. 2009; 104: 3042–3049.
Hyams JS, Griffiths A, Markowitz J, et al. Safety and efficacy of adalimumab for moderate to severe Crohn’s disease in children. Gastroenterology 2012; 143: 365–374.e2.
Sandborn WJ, Feagan BG, Rutgeerts P, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2013; 369: 711–721.
Feagan BG, Rutgeerts P, Sands BE, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013; 369: 699–710.
Singh N, Rabizadeh S, Jossen J, et al. Multi-center experience of vedolizumab effectiveness in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2016; 22: 2121–2126.
Ledder O, Assa A, Levine A, et al. Vedolizumab in paediatric inflammatory bowel disease: a retrospective multi-centre experience from the Paediatric IBD Porto Group of ESPGHAN. J Crohns Colitis. 2017; 11: 1230–1237.
Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2016; 375: 1946–1960.
Amiot A, Filippi J, Abitbol V, et al. Effectiveness and safety of ustekinumab induction therapy for 103 patients with ulcerative colitis: a GETAID multicentre real-world cohort study. Aliment Pharmacol Ther. 2020; 51: 1039–1046. Erratum: Aliment Pharmacol Ther. 2020; 52: 1533.
Rosh JR, Turner D, Griffiths A, et al. Ustekinumab in paediatric patients with moderately to severely active Crohn’s disease: pharmacokinetics, safety, and efficacy results from UniStar, a phase 1 study. J Crohns Colitis 2021; 15: 1931–1942.
Dhaliwal J, McKay HE, Deslandres C, et al. One-year outcomes with ustekinumab therapy in infliximab-refractory paediatric ulcerative colitis: a multicentre prospective study. Aliment Pharmacol Ther. 2021; 53: 1300–1308.
Sandborn WJ, Su C, Sands BE, et al. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017; 376: 1723–1736.
Xantus G, Gyarmathy VA. Cannabis use among patients with inflammatory bowel disease. [Kannabiszszármazékok használatának gyakorisága gyulladásos bélbetegségben.] Orv Hetil. 2021; 162: 443–448. [Hungarian]
Lee YM, Kang B, Lee Y. Infliximab “top-down” strategy is superior to “step-up” in maintaining long-term remission in the treatment of pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2015; 60: 737–743.
Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology. 2021; 160: 1570–1583.
Pinto Pais I, Espinheira MC, Trindade E, et al. Optimizing antitumor necrosis factor treatment in pediatric inflammatory bowel disease with therapeutic drug monitoring. J Pediatr Gastroenterol Nutr. 2020; 71: 12–18.
Papamichael K, Cheifetz AS. Therapeutic drug monitoring in inflammatory bowel disease: for every patient and every drug? Curr Opin Gastroenterol. 2019; 35: 302–310.
Tóbi L, Prehoda B, Balogh A, et al. The gastrointestinal effects of COVID–19 infection during childhood and among the children affected with inflammatory bowel disease. [A COVID–19-fertőzés gastrointestinalis hatásai gyermekkorban és a gyulladásos bélbeteg gyermekekben.] Orv Hetil. 2022; 163: 214–221. [Hungarian]