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Inflammatory bowel disease: recent developments
James John Ashton1,2, R Mark Beattie3
1Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
Insights
Pediatric inflammatory bowel disease (IBD) is rising in children, with new diagnostic tools and advanced therapies like biologics. Personalized treatment strategies are key for managing this complex condition in young patients.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Internal Medicine
Background:
- Pediatric-onset inflammatory bowel disease (IBD) incidence has doubled in 25 years, with increasing prevalence and severity.
- Diagnostic tools for IBD in children have advanced, including fecal calprotectin, small bowel imaging, and capsule endoscopy.
- Management options have expanded, incorporating novel targeted therapies and improved drug monitoring.
Purpose of the Study:
- To summarize recent advancements in the diagnosis, investigation, and management of pediatric IBD.
- To highlight the evolving landscape of IBD care for children and young people.
- To discuss the future of personalized and stratified treatment approaches.
Main Methods:
- Review of recent literature on pediatric IBD diagnosis and management.
- Analysis of advancements in diagnostic technologies.
- Evaluation of emerging therapeutic strategies and monitoring techniques.
Main Results:
- Improved diagnostic accuracy with tools like fecal calprotectin and advanced imaging.
- Introduction of targeted therapies (e.g., anti-IL-12/23, JAK-STAT inhibitors) and refined monitoring of established treatments.
- Recognition of IBD as a disease continuum with diverse phenotypes.
Conclusions:
- Recent developments offer improved diagnostic and management options for pediatric IBD.
- Personalized and stratified treatment strategies, utilizing biomarkers, are crucial for future care.
- Multidisciplinary collaboration within clinical networks is essential for optimal outcomes in pediatric IBD.
Abstract:
Paediatric-onset inflammatory bowel disease (IBD) is a complex and heterogenous condition. Incidence of disease in those aged <18 years has doubled over the last 25 years, with concurrent increased prevalence and no decrease in disease severity. The tools available at diagnosis for investigation have developed over the last 10 years, including better utilisation of faecal calprotectin, improved small bowel imaging and video capsule endoscopy. Alongside this, management options have increased and include biological and small molecule therapies targeting alternative pathways (such as interleukin 12/23, integrins and Janus kinase/signal transducers and activators of transcription, JAK-STAT pathways) and better understanding of therapeutic drug monitoring for more established agents, such as infliximab. Dietary manipulation remains an interesting but contentious topic.This review summarises some of the recent developments in the diagnosis, investigation and management of IBD in children and young people. IBD is increasingly recognised as a continuum of disease, with a proportion of patients presenting with classical Crohn's disease or ulcerative colitis phenotypes. Future implementation of personalisation and stratification strategies, including clinical and molecular biomarkers, implementation of predictors of response and outcome and use of additional therapies, will continue to require working within clinical networks and multiprofessional teams.
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