BRAZILIAN CONSENSUS ON THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASES IN PEDIATRIC PATIENTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)

LOMAZI, Elizete Aparecida; OBA, Jane; RODRIGUES, Maraci; MARMO, Michela Cynthia da Rocha; SANDY, Natascha Silva; SDEPANIAN, Vera Lucia; IMBRIZI, Marcello; BAIMA, Júlio Pinheiro; MAGRO, Daniéla Oliveira; ALBUQUERQUE, Idblan Carvalho de; ZABOT, Gilmara Pandolfo; CASSOL, Ornella Sari; SAAD-HOSSNE, Rogério

doi:10.1590/S0004-2803.2022005S1-04

Elizete Aparecida LOMAZI

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0001-5504-4746

Jane OBA

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Hospital das Clínicas da Universidade de São Paulo, São Paulo, SP, Brasil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-4993-6515

Maraci RODRIGUES

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Hospital das Clínicas da Universidade de São Paulo, São Paulo, SP, Brasil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.

http://orcid.org/0000-0002-1571-5282

Michela Cynthia da Rocha MARMO

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Universidade Federal de Pernambuco; Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil.

http://orcid.org/0000-0001-8388-8292

Natascha Silva SANDY

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brasil.

Hospital Infantil Sabará, São Paulo, SP, Brasil.

http://orcid.org/0000-0002-7744-8984

Vera Lucia SDEPANIAN

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Universidade Federal de São Paulo, Escola Paulista de Medicina, Nestle Health Science, São Paulo, SP, Brasil.

http://orcid.org/0000-0003-2614-710X

Marcello IMBRIZI

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0001-5397-0084

Júlio Pinheiro BAIMA

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

Universidade Nove de Julho, Bauru, SP, Brasil.

Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-4035-3113

Daniéla Oliveira MAGRO

recommendations decision making

Universidade Estadual de Campinas, Campinas, SP, Brasil.

http://orcid.org/0000-0002-8180-6254

Idblan Carvalho de ALBUQUERQUE

recommendations decision making

Serviço de Coloproctologia do Hospital Heliópolis, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-6275-9694

Gilmara Pandolfo ZABOT

recommendations decision making

Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil.

http://orcid.org/0000-0002-1253-4945

Ornella Sari CASSOL

recommendations decision making

Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil.

http://orcid.org/0000-0003-0867-6593

Rogério SAAD-HOSSNE

methodology

literature review

recommendations decision making

writing and review

final review of the manuscript

recommendations decision making

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

http://orcid.org/0000-0002-8166-0304

Corresponding author: Marcello Imbrizi. E-mail: marcelloimbrizi@gmail.com

Conflict of interest: the authors receive support for conferences, lectures, or clinical research at the aforementioned laboratories. Elizete Aparecida Lomazi: Janssen; Jane Oba: Abbvie, Takeda; Maraci Rodrigues: Janssen, Abbvie, Nestle Health Science; Michela Cynthia da Rocha Marmo: Janssen; Natascha Silva Sandy: Abbvie, Nestle Health Science; Vera Lucia Sdepanian: Janssen, Abbvie; Idblan Carvalho de Albuquerque: Abbvie, Takeda, Janssen; Gilmara Pandolfo Zabot: Abbvie, Takeda, Janssen; Júlio Pinheiro Baima: Janssen, Takeda, Pfizer; Marcello Imbrizi: Abbvie, Takeda, Janssen; Ornella Sari Cassol: Janssen, Abbvie, Takeda, Nestle, Buhlmann; Rogério Saad-Hossne: Abbvie, Takeda, Janssen, Pfizer, Sandoz;

Universidade Estadual de Campinas, Campinas, SP, Brasil.

Hospital das Clínicas da Universidade de São Paulo, São Paulo, SP, Brasil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.

Universidade Federal de Pernambuco; Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil.

Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brasil.

Hospital Infantil Sabará, São Paulo, SP, Brasil.

Universidade Federal de São Paulo, Escola Paulista de Medicina, Nestle Health Science, São Paulo, SP, Brasil.

Universidade Nove de Julho, Bauru, SP, Brasil.

Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

Serviço de Coloproctologia do Hospital Heliópolis, São Paulo, SP, Brasil.

Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil.

Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil.

Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

Category	Parameter	Detailed Description	Point
History (recall, 1 wk.)	Abdominal Pain	None	0
		Mild (brief, does not interfere with activities)	5
		Mod/Severe (daily, longer-lasting, affects activities, nocturnal)	10
	Stools (per day)	0-1 liquid stools, no blood	0
		Up to 2 semi-formed with small blood, or 2-5 liquid	5
		Gross bleeding, or ≥6 liquid, or nocturnal diarrhea	10
Patient functioning, general well-being (recall, 1 wk.)	No limitation of activities		0
	Occasional difficulty in maintaining age-appropriate activities		5
	Frequent limitation of activity, very poor		10
Laboratory	Hematocrit (%) (use age-specific reference)	Normal	0
		Mild decrease	2.5
		Mod/severe decrease	5
	Erythrocyte sedimentation rate (mm/h)	<20	0
		20-50	2.5
		>50	5
	Albumin (g/dL)	≥3.5	0
		3.1-3.4	5
		≤3.0	10
Examination	Weight	Weight gain or voluntary weight stable/loss	0
		Involuntary weight stable, weight loss 1-9%	5
		Weight loss ≥10%	10
	Height at diagnosis	<1 channel decrease	0
		≥1, <2 channel decrease	5
		≥2 channel decrease	10
	Height follow-up	Height velocity ≥-1 SD	0
		Height velocity ≥-1 SD, >-2 SD	5
		Height velocity ≥-2 SD	10
	Abdomen	No tenderness, no mass	0
		Tenderness, or mass without tenderness	5
		Tenderness, involuntary guarding, definite mass	10
	Perirectal disease	None, asymptomatic tags	0
		1-2 indolent fistula, scant drainage, no tenderness	5
		Active fistula, drainage, tenderness, or abscess	10
	Extraintestinal manifestations (n)	0	0
		1	5
		≥2	10

	Paris
Age at diagnosis	A1a: 0-<10 y
	A1b: 10- <17 y
	A2: 17-40 y
	A3: >40 y
Location	L1: distal 1/3 ileum ± limited cecal disease
	L2: colonic
	L3: ileocolic
	L4a: upper disease proximal to Ligament of Treitz*
	L4a: upper disease distal to ligament of Treitz and proximal to distal 1/3 ileum*
Behavior	B1: non-structuring non-penetrating
	B2: stricturing
	B3: penetrating
	P: perianal disease modifier
	B2B3: both penetrating and and stricturing disease, either at the same or different times
Growth	G0: No evidence of growth delay
	G1: Growth delay

Item	Points
Abdominal pain
No pain	0
Pain can be ignored	5
Pain cannot be ignored	10
Rectal bleeding
None	0
Small amount only, in < 50% of stools	10
Small amount with most stools	20
Large amount (> 50% of the stool content)	30
Stool consistency of most stools
Formed	0
Partially formed	5
Completely unformed	10
Number of stools per 24 h
0-2	0
3-5	5
6-8	10
>8	15
Nocturnal stools (any episode causing wakening)
No	0
Yes	10
Activity level
No limitation of activity	0
Occasional limitation of activity	5
Severe restricted activity	10
Sum of PUCAI	0-85

	Paris
Extent	E1: ulcerative proctitis
	E2: left-sided UC (distal to splenic flexure)
	E3: extensive (hepatic flexure distally)
	E4: pancolitis (proximal to the hepatic flexure)
Severity	S0: never severe (PUCAI ≥65)
	S1: ever severe (PUCAI ≥65)

Paris classification [at diagnosis]	Additional risk factors	Risk stratification	Suggested induction therapy
B1	None	Low	Exclusive enteral nutrition; corticosteroids
B1	No clinical and biochemical remission 12 weeks after start induction therapy	Medium	Consider accelerated step-up to anti-TNF therapy
B1+G1	Growth delay	Medium	Exclusive enteral nutrition; consider up-front anti-TNF therapy
B1 [L3+L4]	Extensive disease^a or deep colonic ulcers	High	Up-front anti-TNF therapy
B1+p	Perineal disease	High	Up-front anti-TNF therapy in combination with antibiotic therapy, surgery, or both
B2	None	High
	Prestenotic dilatation, obstructive signs, or symptoms, or both		Up-front anti-TNF therapy Bowel resection in combination with postoperative anti-TNF therapy
B3	Prestenotic dilatation, obstructive signs, or symptoms, or both	High	Surgery in combination with postoperative anti-TNF therapy

		Score
Size of ulcers (diameter)	Absent	0
	Aphthous ulcers, 0.1-0.5 cm	1
	Large ulcers, 0.5-2 cm	2
	Very large ulcers, >2 cm	3
Ulcerated surface	None	0
	<10% of the segment	1
	10-30% of the segment	2
	>30% of the segment	3
Affected surface	None	0
	<50% of the segment	1
	50-75% of the segment	2
	>75% of the segment	3
Presence of narrowing	None	0
	Single, passable by the scope	1
	Multiple, passable by the scope	2
	Not passable, frank stenosis	3
	Total SES-CD = scored from 0 to 60

Descriptor (Score most severe lesions)	Likert scale	Definition
Vascular pattern*	Normal (1)	Normal vascular pattern with arborization of capillaries clearly defined, or with blurring or patchy loss of capillary margins
	Patchy obliteration (2)	Patchy obliteration of vascular pattern
	Obliterated (3)	Complete obliteration of vascular pattern
Bleeding*	None (1)	No visible blood
	Mucosal (2)	Some spots or streaks of coagulated blood on the surface of the mucosa ahead of the scope can be washed away.
	Luminal mild (3)	Some free liquid blood in the lumen
	Luminal moderate or severe (4)	Frank blood in the lumen ahead of an endoscope or visible oozing from mucosa after washing intraluminal blood, or visible oozing from a hemorrhagic mucosa
Erosions and ulcers*	None (1)	Normal mucosa, no visible erosions or ulcers
	Erosions (2)	Tiny (≤5 mm) defects in the mucosa, of white or yellow color with a flat edge
	Superficial ulcer (3)	Larger (>5 mm) defects in the mucosa, which are discrete fibrin-covered ulcers when compared with erosions, but remain superficial
	Deep ulcer (4)	Deeper excavated defects in the mucosa, with a slightly raised edge

Study design	Search strategy	Results (titles)
Guidelines and/or Consensus	(“inflammatory bowel disease” [Title] OR “IBD” [Title] OR “crohn” [Title]) AND (“treatment” [Title/Abstract] OR “management”[Title/Abstract] OR “monitoring” [Title/Abstract]) AND (“consensus” [Title] OR “guidelines” [Title]) AND (y_5 [Filter]) AND (english [Filter]) AND (pediatric OR child OR children OR adolescent OR paediatric))	24
Systematic Literature Reviews with meta-analysis	((“inflammatory bowel disease” [Title] OR “IBD” [Title] OR “crohn” [Title]) AND (“treatment” [Title/Abstract] OR “management” [Title/Abstract] OR “monitoring” [Title/Abstract])) AND ((meta-analysis [Filter]) AND (english [Filter]) AND (pediatric OR child OR children OR adolescent OR paediatric))	56

Databases	Search strategy	Results (titles)
Guideline and/or Consensus	(“inflammatory bowel disease” [Title] OR “IBD” [Title/Abstract] OR “Crohn” [Title] OR “DC” [Title/Abstract]) AND (“treatment” OR “management” OR “surgery” OR “surgical”) AND (“consensus” [Title] OR “guidelines” [Title]) AND ((y_5 [Filter]) AND (english [Filter]) AND (pediatric OR child OR children OR adolescent OR paediatric))	31

Study design	Search strategy	Results (titles)
Guidelines and/or Consensus	((“inflammatory bowel disease” [Title] OR “IBD” [Title] OR “ulcerative colitis” [Title]) AND (“treatment” [Title/Abstract] OR “management” [Title/Abstract] OR “monitoring” [Title/Abstract]) AND (“consensus” [Title] OR “guidelines” [Title]) AND “english” [Language])) AND ((y_5 [Filter]) AND (english [Filter]) AND (pediatric OR child OR children OR adolescent OR pediatric))	23
Systematic Literature Reviews with meta-analysis	((“inflammatory bowel disease” [Title] OR “IBD” [Title] OR “ulcerative colitis” [Title]) AND (“treatment” [Title/Abstract] OR “management” [Title/Abstract] OR “monitoring” [Title/Abstract]) AND (“meta-analysis”[Publication Type] AND “English” [Language]) AND (meta-analysis [Filter]) AND (English [Filter]) AND (pediatric OR child OR children OR adolescent OR paediatric))	38

Databases	Search strategy	Results (titles)
Pubmed	(“inflammatory bowel disease” [Title] OR “IBD” [Title/Abstract] OR “ulcerative colitis” [Title] OR “UC” [Title/Abstract]) AND (“treatment” OR “management” OR “surgery” OR “surgical”) AND (“consensus” [Title] OR “guidelines” [Title]) AND ((y_5 [Filter]) AND (english [Filter]) AND (pediatric OR child OR children OR adolescent OR paediatric))	26

Authors, Year	Title	Domain 1 score	Domain 2 score	Domain 3 score	Domain 4 score	Domain 5 score	Domain 6 score	Overall assessment
Amil-Dias et al., 2017	Surgical Management of Crohn Disease in Children: Guidelines from the Paediatric IBD Porto Group of ESPGHAN.	66.7	61.1	52.1	83.3	37.5	66.7	61.2
Bemelman et al., 2018	ECCO-ESCP Consensus on Surgery for Crohn’s Disease.	83.3	94.4	85.4	83.3	62.5	75.0	80.7
Mack et al., 2019	Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease.	66.7	72.2	95.8	100.0	54.2	100.0	81.5
Turner et al., 2018a	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	83.3	94.4	85.4	83.3	62.5	75.0	80.7
Turner et al., 2018b	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.	83.3	94.4	85.4	83.3	62.5	75.0	80.7
Turner et al., 2021	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.	61.1	72.2	64.6	61.1	50.0	91.7	66.8
van Rheenen et al., 2020	The Medical Management of Paediatric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update	83.3	94.4	85.4	83.3	62.5	75.0	80.7
Wei et al., 2017	Management of Crohn’s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.	55.6	38.9	25.0	61.1	37.5	8.3	37.7

Authors, Year	Title	Domain 1 score	Domain 2 score	Domain 3 score	Domain 4 score	Domain 5 score	Domain 6 score	Overall assessment
Turner et al., 2018b	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.	18	20	49	18	19	11	80.7
Turner et al., 2018a	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	18	20	49	18	19	11	80.7

Author	Colman	Dziechciarz	Gisbert	Kaur	Narula	Rolfe	Ungaro	Yu
Year	2018	2007	2007	2020	2018	2006	2020	2019
1. Did the research questions and inclusion criteria for the review include the components of PICO?	No	Yes	No	Yes	Yes	Yes	Yes	Yes
2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?	No	No	No	Yes	Yes	Yes	Partial	No
3. Did the review authors explain their selection of the study designs for inclusion in the review?	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes
4. Did the review authors use a comprehensive literature search strategy?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
5. Did the review authors perform study selection in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
6. Did the review authors perform data extraction in duplicate?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
7. Did the review authors provide a list of excluded studies and justify the exclusions?	Partial	Yes	Partial	Yes	Yes	Yes	No	No
8. Did the review authors describe the included studies in adequate detail?	Partial	Partial	Yes	Yes	Yes	Yes	Yes	Yes
9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
10. Did the review authors report on the sources of funding for the studies included in the review?	No	No	No	Yes	Yes	Yes	Yes	Yes
11. If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	Yes	No	Yes	Yes	Yes	Yes	No	No
13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?	No	No	No	Yes	Yes	Yes	No	No
14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?	No	N/A	Yes	Yes	Yes	Yes	No	No
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Rating overall	Critically low	Critically low	Critically low	High	High	High	Critically low	Critically low

[1] Corresponding author: Marcello Imbrizi. E-mail: marcelloimbrizi@gmail.com

P	Children and adolescents (≤18 years) with low-risk active CD
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆Anti-Integrin (vedolizumab)
	◆Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to the last five years.

P	Children and adolescents (≤18 years) with intermediate-risk active CD.
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆Anti-Integrin (vedolizumab)
	◆Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to the last five years.

P	Children and adolescents (≤18 years) with high-risk active CD.
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆Anti-Integrin (vedolizumab)
	◆Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to the last five years.

P	Children and adolescents (≤18 years) with low-risk active CD.
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆Anti-Integrin (vedolizumab)
	◆Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to the last five years

P	Children and adolescents (≤18 years) with intermediate-risk active CD.
I	• Corticosteroids (budesonide of ileal release, budesonide mmx + all traditional)
	• Probiotics
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository and enema)
	• Immunosuppressants (azathioprine, 6MP, MTX)
	• Biological
	◆Anti-TNF (infliximab, adalimumab, certolizumab pegol)
	◆Anti-Integrin (vedolizumab)
	◆Anti-Interleukin (ustekinumab, risankizumab)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to the last five years.

Brasil

Brasil

BRAZILIAN CONSENSUS ON THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASES IN PEDIATRIC PATIENTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)

Consenso brasileiro de manejo das doenças inflamatórias intestinais em pacientes pediátricos: Consenso da Organização Brasileira para doença de Crohn e colite (GEDIIB)

ABSTRACT

Background:

Objective:

Methods:

Results and conclusion:

P	Children and adolescents (≤18 years) with low-risk and intermediate-risk CD
I	Nutritional diets:
	• EXCLUSIVE ENTERAL DIET
	• PARTIAL EXCLUSION DIET
C	• Not applicable
O	Efficacy:
	• Clinical response and remission
	• Endoscopic response and remission
	• Mucosal healing
Type of study	Systematic reviews with meta-analysis

P	Children and adolescents (≤18 years) with abdominal CD
I	Elective surgery
C	Not applicable
O	Criteria to indicate elective or urgent surgery
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with abdominal CD
I	Perioperative management
C	Not applicable
O	• Nutrition
	• Prophylaxis of venous thromboembolism
	• Sepsis control
	• Corticosteroids
	• Immunosuppressants
	• Anti-TNF
	• Anti-integrin
	• Anti-interleukin
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with small bowel and perianal fistulizing CD
I	Management of Crohn’s disease - Small bowel and perianal fistulizing disease
C	Not applicable
O	• Management of intra-abdominal and perianal abscess
	• Percutaneous drainage guided by imaging
	• Clinical treatment of intra-abdominal and perianal abscess
	• Surgical treatment of intra-abdominal and perianal abscess
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with enterovaginal, enterocutaneous, enterovesical, and/or enteroenteric fistula CD
I	Management of Crohn’s disease - Entero-vaginal, entero-bladder, enterocutaneous, enteroenteric fistula
C	Not applicable
O	• enterovaginal fistula management
	• enterovesical fistula management
	• enteroenteric fistula management
	• enterocutaneous fistula management
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with CD and enteroenteric fistula
I	Management of CD - Enteroenteric fistula
C	Not applicable
O	• Management of intra-abdominal abscess
	• Percutaneous drainage guided by imaging
	• Clinical treatment of intra-abdominal abscess
	• Surgical treatment of intra-abdominal abscess
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with CD with enterocutaneous fistula
I	Management of CD - enterocutaneous fistula
C	Not applicable
O	• Management of intra-abdominal abscess
	• Percutaneous drainage guided by imaging
	• Clinical treatment of intra-abdominal abscess
	• Surgical treatment of intra-abdominal abscess
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with CD
I	Management of stenosing CD
C	Not applicable
O	• Endoscopic treatment
	• Surgical Treatment (Stenoplasty and Resection)
Type of study	International guidelines and/or consensus published after 2016

P	Children and adolescents (≤18 years) with mild active UC
I	• Corticosteroids (budesonide mmx + all traditional)
	• Salicylates (sulfasalazine, mesalazine, mesalazine mmx, suppository, and enema)
	• Immunosuppressants (azathioprine, 6MP, cyclosporine, tacrolimus)
	• Biological
	◆Anti-TNF (infliximab, golimumab, adalimumab)
	◆Anti-Integrin (vedolizumab)
	◆Anti-Interleukin (ustekinumab)
	• JAK inhibitors (tofacitinib, upadacitinib)
C	Not applicable
O	Consensus and/or guideline recommendation
Type of study	Consensus and/or guidelines limited to the last five years.

P	Children and adolescents (≤18 years) with ASC
I	Urgent and emergency surgery
C	Not applicable
O	Criteria for indication of urgent and emergency surgery
Type of study	International guidelines and/or consensus published after 2016