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

Affiliations
  • 1Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. mjschj@snu.ac.kr

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.


Cited by  1 articles

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Mi Jin Kim, Sung Noh Hong, Young-Ho Kim, Yon Ho Choe
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Reference

1. Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis. 2008; 14:Suppl 2. S9–S11.
Article
2. Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis. 2011; 17:423–439.
Article
3. Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology. 2013; 145:158–165.e2.
Article
4. Ong C, Aw MM, Liwanag MJ, Quak SH, Phua KB. Rapid rise in the incidence and clinical characteristics of pediatric inflammatory bowel disease in a South-East Asian cohort in Singapore, 1994-2015. J Dig Dis. 2018; 19:395–403.
Article
5. Hong SJ, Cho SM, Choe BH, Jang HJ, Choi KH, Kang B, et al. Characteristics and incidence trends for pediatric inflammatory bowel disease in Daegu-Kyungpook province in Korea: a multi-center study. J Korean Med Sci. 2018; 33:e132.
Article
6. Van Limbergen J, Russell RK, Drummond HE, Aldhous MC, Round NK, Nimmo ER, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008; 135:1114–1122.
Article
7. Sauer CG, Kugathasan S. Pediatric inflammatory bowel disease: highlighting pediatric differences in IBD. Gastroenterol Clin North Am. 2009; 38:611–628.
Article
8. Rinawi F, Assa A, Hartman C, Mozer Glassberg Y, Friedler VN, Rosenbach Y, et al. Incidence of bowel surgery and associated risk factors in pediatric-onset Crohn's disease. Inflamm Bowel Dis. 2016; 22:2917–2923.
Article
9. Ruemmele FM, Turner D. Differences in the management of pediatric and adult onset ulcerative colitis: lessons from the joint ECCO and ESPGHAN consensus guidelines for the management of pediatric ulcerative colitis. J Crohns Colitis. 2014; 8:1–4.
Article
10. Charpentier C, Salleron J, Savoye G, Fumery M, Merle V, Laberenne JE, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014; 63:423–432.
Article
11. Jakobsen C, Bartek J Jr, Wewer V, Vind I, Munkholm P, Groen R, et al. Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease: a population-based study. Aliment Pharmacol Ther. 2011; 34:1217–1224.
Article
12. Vernier-Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, et al. Natural history of pediatric Crohn's disease: a population-based cohort study. Gastroenterology. 2008; 135:1106–1113.
Article
13. Heyman MB, Kirschner BS, Gold BD, Ferry G, Baldassano R, Cohen SA, et al. Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr. 2005; 146:35–40.
Article
14. Uhlig HH, Schwerd T, Koletzko S, Shah N, Kammermeier J, Elkadri A, et al. The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology. 2014; 147:990–1007.
Article
15. Glocker EO, Kotlarz D, Boztug K, Gertz EM, Schäffer AA, Noyan F, et al. Inflammatory bowel disease and mutations affecting the interleukin-10 receptor. N Engl J Med. 2009; 361:2033–2045.
Article
16. Shim JO, Hwang S, Yang HR, Moon JS, Chang JY, Ko JS, et al. Interleukin-10 receptor mutations in children with neonatal-onset Crohn's disease and intractable ulcerating enterocolitis. Eur J Gastroenterol Hepatol. 2013; 25:1235–1240.
Article
17. Shim JO, Seo JK. Very early-onset inflammatory bowel disease (IBD) in infancy is a different disease entity from adult-onset IBD; one form of interleukin-10 receptor mutations. J Hum Genet. 2014; 59:337–341.
Article
18. Engelhardt KR, Shah N, Faizura-Yeop I, Kocacik Uygun DF, Frede N, Muise AM, et al. Clinical outcome in IL-10- and IL-10 receptor-deficient patients with or without hematopoietic stem cell transplantation. J Allergy Clin Immunol. 2013; 131:825–830.
Article
19. Ko JS. Is infantile inflammatory bowel disease curable with hematopoietic stem cell transplantation? Korean J Gastroenterol. 2013; 62:313–314.
Article
20. Snapper SB. Very-early-onset inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2015; 11:554–556.
21. Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011; 17:1314–1321.
Article
22. Kim KY, Lee EJ, Kim JW, Moon JS, Jang JY, Yang HR, et al. Higher Morbidity of monogenic inflammatory bowel disease compared to the adolescent onset inflammatory bowel disease. Pediatr Gastroenterol Hepatol Nutr. 2018; 21:34–42.
Article
23. Tsianos EV, Katsanos KH, Tsianos VE. Role of genetics in the diagnosis and prognosis of Crohn's disease. World J Gastroenterol. 2012; 18:105–118.
Article
24. Bianco AM, Girardelli M, Tommasini A. Genetics of inflammatory bowel disease from multifactorial to monogenic forms. World J Gastroenterol. 2015; 21:12296–12310.
Article
25. Bouguen G, Levesque BG, Feagan BG, Kavanaugh A, Peyrin-Biroulet L, Colombel JF, et al. Treat to target: a proposed new paradigm for the management of Crohn's disease. Clin Gastroenterol Hepatol. 2015; 13:1042–1050.e2.
Article
26. Kang B, Choe YH. Early biologic treatment in pediatric Crohn's disease: catching the therapeutic window of opportunity in early disease by treat-to-target. Pediatr Gastroenterol Hepatol Nutr. 2018; 21:1–11.
Article
27. Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis. 2014; 8:1179–1207.
Article
28. Hyams JS, Ferry GD, Mandel FS, Gryboski JD, Kibort PM, Kirschner BS, et al. Development and validation of a pediatric Crohn's disease activity index. J Pediatr Gastroenterol Nutr. 1991; 12:439–447.
Article
29. Turner D, Otley AR, Mack D, Hyams J, de Bruijne J, Uusoue K, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007; 133:423–432.
Article
30. Danese S, Colombel JF, Reinisch W, Rutgeerts PJ. Review article: infliximab for Crohn's disease treatment: shifting therapeutic strategies after 10 years of clinical experience. Aliment Pharmacol Ther. 2011; 33:857–869.
Article
31. Noh SY, Oh SY, Kim SH, Kim HY, Jung SE, Park KW. Fifteen-year-old colon cancer patient with a 10-year history of ulcerative colitis. World J Gastroenterol. 2013; 19:2437–2440.
Article
32. Philpott JR, Kurowski JA. Challenges in transitional care in inflammatory bowel disease: a review of the current literature in transition readiness and outcomes. Inflamm Bowel Dis. 2019; 25:45–55.
Article
33. van Rheenen PF, Aloi M, Biron IA, Carlsen K, Cooney R, Cucchiara S, et al. European Crohn's and Colitis Organisation topical review on transitional care in inflammatory bowel disease. J Crohns Colitis. 2017; 11:1032–1038.
Article
34. Brooks AJ, Smith PJ, Cohen R, Collins P, Douds A, Forbes V, et al. UK guideline on transition of adolescent and young persons with chronic digestive diseases from paediatric to adult care. Gut. 2017; 66:988–1000.
Article
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