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Diagnosis and management of inflammatory bowel disease in children
Ryan Carvalho1, Jeffrey S Hyams
1Children's Medical Center, Wright University and Boonshoft School of Medicine, Dayton, Ohio, USA.
Insights
Inflammatory bowel disease (IBD) affects over 100,000 US children, with rising global incidence. Newer therapies like biologics improve outcomes, but long-term effects and rare complications require further study.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Immunology
Background:
- Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, affects over 100,000 children and adolescents in the US.
- Global incidence of IBD is increasing, necessitating advancements in diagnosis and treatment.
- Current diagnostic methods rely on clinical, radiographic, endoscopic, and histological findings.
Purpose of the Study:
- To review current diagnostic and therapeutic strategies for pediatric inflammatory bowel disease.
- To highlight the evolving role of serological tests and videocapsule endoscopy in IBD diagnosis.
- To discuss the efficacy and safety of emerging therapies, including immunomodulators and biologics.
Main Methods:
- Review of recent literature on pediatric IBD diagnosis and management.
- Analysis of clinical trial data and observational studies on therapeutic interventions.
- Synthesis of information on diagnostic advancements and treatment outcomes.
Main Results:
- Aminosalicylates show limited efficacy in Crohn's disease; corticosteroids often lead to dependence.
- Early use of immunomodulators is standard and reduces corticosteroid dependence.
- Biologic therapies, such as infliximab, have significantly improved short-term outcomes for both Crohn's disease and ulcerative colitis.
Conclusions:
- While biologics offer improved short-term outcomes, their long-term impact on IBD natural history requires further investigation.
- Aggressive therapies are associated with rare but serious complications, including lymphoma and opportunistic infections.
- Continued research is crucial for optimizing pediatric IBD management and addressing treatment-related risks.
Abstract:
Upwards of 100,000 children and adolescents are affected by inflammatory bowel disease (IBD) in the United States, and the incidence of IBD appears to be increasing worldwide. Although the diagnosis and differentiation of Crohn's disease or ulcerative colitis is still based on clinical, radiographic, endoscopic, and histological findings, newer less invasive serological tests are being employed to help distinguish these disorders and provide prognostic information to possibly guide therapy. Videocapsule endoscopy has increased our ability to detect previously unrecognized small bowel inflammation in selected patients. Whereas initial therapy has historically included aminosalicylates and corticosteroids, recent data suggest the limited efficacy of aminosalicylates in Crohn's disease and the high likelihood or corticosteroid dependence in patients with either Crohn's disease or ulcerative colitis. The early use of immunomodulators has become standard-of-care in both disorders and has decreased corticosteroid dependence. The advent of biologic therapy, primarily with infliximab, has dramatically improved short-term outcomes in both Crohn's disease and ulcerative colitis. Longer-term data on whether infliximab changes the natural history of these disorders (eg, requirement for surgery) awaits further study. As more aggressive therapy is being increasingly employed, rare complications such as lymphoma or opportunistic infection have developed.
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