Pediatric Inflammatory Bowel Disease

Abstract

Inflammatory bowel diseases (IBDs) are chronic, immune-mediated disorders that include Crohn’s disease and ulcerative colitis. A pediatric onset of disease occurs in about 10% of all cases. Clinical presentation of IBD with rectal bleeding or perianal disease warrants direct referral for endoscopic evaluation. In the absence of red-flag symptoms, a combination of patient history and blood and fecal biomarkers can help to distinguish suspected IBD from other causes of abdominal pain or diarrhea. The therapeutic management of pediatric IBD has evolved by taking into account predictors of poor outcome, which justifies the upfront use of anti-tumor necrosis factor therapy for patients at high risk for complicated disease. In treating patients with IBD, biochemical or endoscopic remission, rather than clinical remission, is the therapeutic goal because intestinal inflammation often persists despite resolution of abdominal symptoms. Pediatric IBD comes with unique additional challenges, such as growth impairment, pubertal delay, the psychology of adolescence, and development of body image. Even after remission has been achieved, many patients with IBD continue to experience nonspecific symptoms like abdominal pain and fatigue. Transfer to adult care is a well-recognized risk for disease relapse, which highlights patient vulnerability and the need for a transition program that is continued by the adult-oriented IBD team. The general pediatrician is an invaluable link in integrating these challenges in the clinical care of patients with IBD and optimizing their outcomes. This state-of-the-art review aims to provide general pediatricians with an update on pediatric IBD to facilitate interactions with pediatric gastrointestinal specialists.

Imaging and endoscopic tools in pediatric inflammatory bowel disease: What’s new?

“…Inflammatory bowel disease (IBD) is a chronic inflammatory disorder consisting of Crohn’s disease (CD), ulcerative colitis (UC), and IBD unclassified[ 1 , 2 ]. The incidence of IBD continues to rise, including pediatric-onset disease, with most recent estimates approaching 1.5-2.0 per 10000 person years in areas with the highest rates of disease (Europe, North America)[ 3 ].…”

Physical Fitness and Inflammatory Bowel Disease Risk Among Children and Adolescents in Taiwan

“…Inflammatory bowel diseases (IBDs), including Crohn disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract without definite etiologies. Approximately 10% of IBD cases are of pediatric onset . The incidence of pediatric-onset IBD has increased worldwide in the past 2 decades and has become a global disease burden in both high-income and low- to middle-income countries .…”

“…Approximately 10% of IBD cases are of pediatric onset. 1 The incidence of pediatric-onset IBD has increased worldwide in the past 2 decades and has become a global disease burden in both high-income and low-to middle-income countries. [2][3][4][5] A population-based study reported that the prevalence of pediatric-onset IBD in Canada increased substantially from 33.2 per 100 000 in 2000 to 46.2 per 100 000 in 2008.…”

Prognosis of pediatric ulcerative colitis after infliximab failure: A multicenter registry‐based cohort study

“…Despite increasing numbers of biologic agents and small‐molecule drugs for UC, only two biologics, infliximab (IFX), and adalimumab, are approved by regulators for use in children in many countries, including the US Food and Drug Administration, the European Medicines Agency, and the Japanese Pharmaceuticals and Medical Devices Agency. By necessity, IFX continues to be an important option for treating moderate to severe pediatric UC 2 that is steroid‐dependent or steroid‐refractory 3 . Patients with IFX failure involving ineffectiveness or discontinuation due to adverse effects are considered likely to require colectomy, but few reports have examined factors that could decrease need for colectomy in pediatric patients with IFX failure.…”