Systematic Review of the Evidenc e Base for the Medical T reatment of Paediatric Inflammato r y Bowel Disease

Objective: To sy st em ati ca ll y rev ie w the ev ide nc e b a s e f o r th e m e dic al (p ha rma ceu ti ca l a n d nu tr it io na l) tr ea tm en t o f p a e d i a t r i c i n fl a m m a t o r y bo we l di se as e. Methods: K e y c l ini ca l q u e s t i o n s we re fo rm ul ate d reg ar din g d i f f ere nt tr eat me nt mo da li ti es us ed in th e t r eat me nt of pa ed ia tr ic (n ot ad ul t- on se t) IB D, in pa rt ic ul ar th e ind uc ti on an d m a i n ten an ce of rem is sio n i n C r o h n dis ea se an d u l c e rat ive co li ti s. El ect ro ni c s e arc he s w e r e p e rfo rm ed fro m J a n u a r y 19 66 to De ce mb er 20 06 , u s ing th e e l e c t r o n i c s e arc h str at eg y o f t h e Co ch ra ne IB D gr ou p. De ta il s o f p a p e r s w e r e e n t e r e d on a d e d i cat ed da ta ba se , rev ie we d i n ab st rac t f o r m , an d d i s s e m ina te d i n f u l l f o r ap pr ais al . C l ini ca l g u i d e l ine s w e r e ap pr ais ed us in g the A G R E E i n str um en t a n d al l o t h e r re le va nt pa pe rs we re ap pr ais ed us in g S c o t t i s h I n t e r c oll eg ia te Gu ide li ne s N e t w o r k me th od olo gy , wi th ev ide nc e l e v e l s g i v e n to al l p a p e r s . Results: A total of 6285 papers were identified , o f which 1255 involved children; these were entered on the database. After critical appraisal, only 103 publications met our criteria as evidence on medical treatment of paediatric IBD. We identified 3 clinical guidelines, 1 systematic review, and 16 randomised controlled trials; all were of variable quality, with none getting the highest methodologi cal scores. Conclusio ns: This is the first comprehensi ve review of the evidence base for the treatment of paediatric IBD, highlighting the paucity of trials of high methodologi cal quality. As a result, the developme nt of clinical guidelines for managing children and young people with IBD must be consensus based, informed by the best-available evidence from the paediatric literature and high-quality data from the adult IBD literature , together with the clinical expertise and multidisci plinary experience of paediatric IBD experts. (JPGN 2010;50: S14 – S34)