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Challenges in the Management of Inflammatory Bowel Disease in Children: A Narrative Review
Wathsala Hathagoda1,2, Shaman Rajindrajith1,2, Madunil Anuk Niriella3
1Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka.
Insights
Pediatric inflammatory bowel disease (PIBD) management presents unique challenges, including atypical presentations and developmental impacts. Addressing these requires comprehensive, multidisciplinary approaches for better outcomes in children and adolescents.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Management Strategies
Background:
- Rising global prevalence of pediatric inflammatory bowel disease (PIBD).
- PIBD necessitates specialized management distinct from adult forms.
- Existing literature highlights significant challenges in PIBD care.
Purpose of the Study:
- To explore key management issues in PIBD.
- To propose evidence-based recommendations for PIBD care.
- To address the unique complexities of PIBD in pediatric populations.
Main Methods:
- Comprehensive literature review across major scientific databases (PubMed, Cochrane, Web of Science, Scopus).
- Inclusion of diverse study types: original research, systematic reviews, meta-analyses, consensus statements, and position papers.
- Critical appraisal and synthesis of selected articles for evidence-based recommendations.
Main Results:
- PIBD presents multifaceted challenges: atypical presentations, early-onset disease, and growth/nutritional issues.
- Pharmacological and surgical management requires age-specific considerations for safety and efficacy.
- Significant psychosocial burdens impact education, social development, and family dynamics.
- Access to specialized PIBD services and transitional care presents limitations.
Conclusions:
- PIBD requires identification and comprehensive management of its unique challenges.
- A multidisciplinary approach is crucial for addressing the complexities of PIBD.
- Evidence-based recommendations are needed to optimize care for children and adolescents with IBD.
Abstract:
There is a rising prevalence of pediatric inflammatory bowel disease (PIBD) worldwide. This article aims to explore the key issues in managing PIBD and attempts to propose evidence-based recommendations. We reviewed published literature on PIBD, including original research, systematic reviews, meta-analyses, consensus statements, and position papers. The databases searched were PubMed/MEDLINE, Cochrane Library, Web of Science, and Scopus, using terms related to inflammatory bowel disease, colitis, ulcerative colitis, Crohn's disease, children, adolescents, and pediatrics. The selected articles were critically appraised, summarised and incorporated into the review. PIBD presents multifaceted challenges. They include atypical presentations, very early onset cases, growth and nutritional challenges that affect linear development and pubertal progression, pharmacological management issues related to age-specific medication safety and efficacy and timing of surgical interventions. There are impacts on development; psychosocial burden challenges in education, social development, and family dynamics, all crucial in the future of the child. There are also limitations in access to PIBD services with personalised treatment approaches and challenges in transitional care. It is important to identify these unique challenges posed by PIBD and address them in a comprehensive manner in a multidisciplinary approach.
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