The overall goal in IBD management for the treating clinicians as well as for emergency clinicians is to induce remission and minimize flares. The selection of 1 or more therapeutic agents is guided by the severity and extent of gastrointestinal and extragastrointestinal manifestations. Maintenance medications are used, with additional medication interventions as needed, for acute flares. The effectiveness of various therapies is difficult to assess because there are few adequately powered, high-quality pediatric studies available. The current published data include studies with methodological shortcomings and are frequently cohort studies.55 Exclusive enteral nutrition in which the patient only receives elemental formula (via mouth, nasogastric tube, or gastrostomy tube) as the sole source of nutrition has been shown to effectively induce remission in children with IBD. This therapy is more common in Canada and Western Europe and is used less commonly in the United States. Adherence is difficult, and exclusive enteral nutrition may be required for 6 to 8 weeks to induce remission.
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