STEP-UP AND TOP-DOWN APPROACHES IN THE TREATMENT OF PEDIATRIC INFLAMMATORY BOWEL DISEASE

Abstract

Objective: To compare the efficacy of step-up and top-down treatment approaches in paediatric inflammatory bowel disease. Study Design: Randomised controlled trial. Duration and Place of Study: Conducted from 29 October 2025 to 29 March 2026 at the Department of Paediatrics Combined Military Hospital, Rawalpindi. Methodology: A total of 68 children aged 2 to 17 years with Crohn disease were included. Group A received step-up therapy and Group B received top-down therapy. Clinical remission was assessed after 4 weeks using paediatric Crohn disease activity index score less than 10. Data were analysed using IBM SPSS version 26. Chi square test and Fisher exact test were applied and p-value less than 0.05 was considered significant. Results: Mean age was 9.21 ± 4.48 years in Group A and 7.76 ± 3.46 years in Group B. Males were 20 (58.8%) in Group A and 19 (55.9%) in Group B. Overall efficacy was significantly higher in top-down group with 26 (76.5%) compared to 7 (20.6%) in step-up group (p<0.001). Treatment failure was 27 (79.4%) in Group A and 8 (23.5%) in Group B. Significant associations of efficacy were observed with age (p=0.003), gender (p=0.001), weight (p=0.001), residential status (p=0.001), socioeconomic status (p=0.001), and disease duration (p<0.001). Conclusion: Top-down therapy show more effective results in achieving clinical remission in paediatric inflammatory bowel disease as compared to step-up therapy.