Child/Adolescent Health

Treatments for pediatric Crohn's disease cases vary widely in North America

Clinicians vary in their care for children with Crohn's disease (CD) because of sparse standard clinical practice guidelines and the wealth of available treatments, a new study finds. These care variations can result in differences in health care costs, quality, and outcomes.

Michael D. Kappelman, M.D., of Harvard Medical School, led a team of researchers who reviewed treatments given to 311 children newly diagnosed with CD at 10 gastroenterology centers in the United States and Canada from January 2002 to August 2005. They looked at which drugs children were given to manage their CD, a chronic inflammatory bowel disease. CD is thought to be caused by the immune system attacking the lining of the gastrointestinal system. It can cause abdominal pain, diarrhea, gastrointestinal bleeding, and impaired growth, and sometimes may lead to life-threatening complications.

Physicians used several types of drugs to reduce children's symptoms. Immunomodulators, which adjust the body's immune response, were used in anywhere from 29 to 97 percent (with a median of 56 percent) of patients. These drugs offer the most benefit but also the most risk, which may explain the variation, researchers suggest. Also used were steroids (32 to 88 percent), antibiotics (11 to 69 percent), anti-inflammatories (18 to 92 percent), and an antibody that reduces inflammation called infliximab (3 to 21 percent). Treatment variation was less with infliximab, most likely because clinical trials have defined when it should be used.

These differing approaches suggest a need for more clinical trials to create a consensus on how to treat children with CD. Standard practice guidelines based on clinical evidence will improve the safety and quality of the care these chronically ill children receive. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00063).

See "Intercenter variation in initial management of children with Crohn's disease," by Dr. Kappelman, Athos Bousvaros, M.D., Jeffrey Hyams, M.D., and others in the July 2007 Inflammatory Bowel Disease 13(7), pp. 890-895.

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