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The Management Approach to the Adolescent IBD Patient: Health Maintenance and Medication Considerations

Abstract

Purpose of Review

Inflammatory bowel disease (IBD) is often diagnosed during adolescence and can have a deep impact on the physical, hormonal, developmental, and psychosocial changes associated with this life period. The purpose of this review is to address the particular manifestations of IBD (such as growth and pubertal delay), health maintenance issues, and treatment considerations in the adolescent.

Recent Findings

The need for a multidisciplinary approach to recognize and address growth and pubertal delay, bone health, as well as the psychosocial impact of IBD on the adolescent has been increasingly recognized as an integral part of IBD care in this population. Vaccinations schedule, preventive health measures, and promoting compliance with care are particularly important during adolescence. Replacing nutrients deficits is also crucial: in particular, vitamin D has been shown to play a role in the gut immune system, and adequate vitamin D levels might promote IBD remission. Iron replacement should be done by intravenous route since oral iron is poorly absorbed in chronic inflammatory states. Finally, recent data have shed light on the increased risk of particular types of lymphoma in adolescent on thiopurines, whereas biologic therapies, in particular, anti-TNF, now are positioned as a preferred and effective steroid-sparing agents in moderate to severe IBD.

Summary

Management of adolescents with IBD is not without significant challenges. An early implementation of steroid-sparing therapies, a multidisciplinary treatment approach, and a dynamic physician-patient relationship are essential to achieve remission, prevent disease-related complications but also optimize developmental, physical, and psychosocial health, and encourage compliance and transition to adult care.

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Correspondence to Aline Charabaty.

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Aline Charabaty reports working as a consultant for Takeda; sits on the advisory board for Takeda and Janssen, and receives speaker fees from Abbvie and Takeda.

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Steinberg, J.M., Charabaty, A. The Management Approach to the Adolescent IBD Patient: Health Maintenance and Medication Considerations. Curr Gastroenterol Rep 22, 5 (2020). https://doi.org/10.1007/s11894-019-0739-9

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Keywords

  • Inflammatory bowel disease
  • IBD
  • Crohn’s disease
  • Ulcerative colitis
  • Pediatric IBD
  • Adolescent IBD
  • Adolescent medicine
  • Adolescent health maintenance