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Pediatric Aspects of Inflammatory Bowel Disease

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Crohn's Disease and Ulcerative Colitis

Abstract

Children and adolescents make up from 15 % to 20 % of all newly diagnosed individuals with inflammatory bowel disease. Approximately 30 % of pediatric patients are less than 10 years of age at diagnosis with the remainder in their pre-teen or teenage years. Rarely, children develop IBD in infancy or early childhood. Recent work has demonstrated that very early onset IBD may be associated with a number of monogenic disorders such as loss of function in IL-10 receptor genes. The diagnosis of IBD is usually straightforward and includes standard endoscopic evaluation and biopsy. A push toward minimizing the use of ionizing radiation has prompted increasing utilization of magnetic resonance enterography. As in adults, treatment is directed toward elimination of signs and symptoms of inflammation, but the bar in children is raised even higher as therapy must also promote normal growth and development. The concept of “treat to target “is also now applicable to pediatric IBD with mucosal healing now in reach with the advent of biologic therapy with anti-TNF agents. Whether monotherapy or combination therapy is best continues to be debated though recent evidence strongly suggests that durability of anti-TNF therapy is improved with combination therapy. However, the choice of a thiopurine versus methotrexate as the combination agent continues to engender considerable debate. Risk versus benefit remains an important element of the discussion with patients and families.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, The Ohio State University College of Medicine and Public Health, 700 Children’s Drive, Columbus, OH, 43205, USA

    Brendan Boyle M.D., M.P.H.

  2. Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT, 06106, USA

    Jeffrey S. Hyams M.D.

  3. University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT, 06106, USA

    Jeffrey S. Hyams M.D.

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  1. Brendan Boyle M.D., M.P.H.
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  2. Jeffrey S. Hyams M.D.
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Correspondence to Jeffrey S. Hyams M.D. .

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Editors and Affiliations

  1. Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School—Humboldt-University of Berlin, Berlin, Germany

    Daniel C. Baumgart

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Boyle, B., Hyams, J.S. (2017). Pediatric Aspects of Inflammatory Bowel Disease. In: Baumgart, D. (eds) Crohn's Disease and Ulcerative Colitis. Springer, Cham. https://doi.org/10.1007/978-3-319-33703-6_58

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