Pediatr Gastroenterol Hepatol Nutr.  2019 Jan;22(1):50-56. 10.5223/pghn.2019.22.1.50.

Clinical Aspects and Treatments for Pediatric Inflammatory Bowel Diseases

• Moon JS

• KMID: 2430915
• DOI: http://doi.org/10.5223/pghn.2019.22.1.50

Abstract

The incidence of pediatric inflammatory bowel disease (IBD) is increasing worldwide, especially in the developing countries. It differs from adult disease in clinical manifestations, especially with regard to genetic predisposition in monogenic IBD. Pediatric disease also have a tendency to show more aggressive inflammation and greater extent of lesion. Newer drugs such as anti-tumor necrosis factor α have been known to make a difference in treating pediatric IBD. Recent studies suggested that the patients with high risk factors might have some benefits from earlier use of biologics. To achieve treatment goals such as relieving symptoms, optimizing growth, and improving quality of life while minimizing drug toxicity, more research is needed to develop tools for risk stratification in the use of biologics for pediatric IBD.

Keyword

Pediatrics; Inflammatory bowel diseases; Crohn disease; Ulcerative colitis; Anti-tumor necrosis factor-α blockers

MeSH Terms

Adult
Biological Products
Colitis, Ulcerative
Crohn Disease
Developing Countries
Drug-Related Side Effects and Adverse Reactions
Genetic Predisposition to Disease
Humans
Incidence
Inflammation
Inflammatory Bowel Diseases*
Necrosis
Pediatrics
Quality of Life
Risk Factors
Biological Products

Figure

• 

  Fig. 1 Simplified treatment algorithm for pediatric CD according to risk factors. Dashed line indicates early use of biologics, that is, the “top down” strategy. High-risk factors in children for luminal CD are deep colonic ulcerations, extensive disease, marked growth retardation, severe osteoporosis, B2 and/or B3 behavior, and severe perianal disease [27]. Generally accepted risk factors are a history of more than 2 steroid courses, steroid dependence, hospitalization, chronic (>12 months) symptoms, need for immunosuppressants or need for surgery, terminal ileal location, stricturing and penetrating behavior, smoking, positive serologic markers such as Anti-Saccharomyces cerevisiae antibody/perinuclear antineutrophil cytoplasmic antibodies, positive genetic markers such as NOD2/IBD5, and elevated C-reactive protein [30]. CD: crohn disease, TNF: tumor necrosis factor, ASA: aminosalicylic acid.

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