Inflammatory bowel disease

Overview & Definition

A school-age child or teenager who presents with months of diarrhoea, abdominal pain, weight loss, and a fall in their growth centiles is the classic picture of paediatric inflammatory bowel disease. This is a group of chronic, relapsing, immune-mediated disorders of the gastrointestinal tract in which an inappropriate inflammatory response damages the gut, and in children the consequences for growth, puberty, and psychosocial development are as important as the bowel symptoms themselves. [1]

The two main subtypes are Crohn disease, which can affect any segment from mouth to anus with transmural and patchy inflammation, and ulcerative colitis, which is confined to the colonic mucosa in continuous fashion from the rectum. A third group, IBD-unclassified, is reserved for colitis that cannot be definitively categorised as either at the time of diagnosis. In children the distinction matters because it drives the choice of induction and maintenance therapy and shapes the long-term risk of surgery, cancer, and growth failure. [1]

What sets paediatric IBD apart from the adult disease is growth. Up to half of children with Crohn disease have impaired growth at presentation, driven by a combination of chronic inflammation, malnutrition, and prolonged corticosteroid exposure. This is why every management plan, regardless of the drug chosen, must protect and ideally restore linear growth, and why growth-centred induction strategies such as exclusive enteral nutrition are preferred where evidence supports them. [2]

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2. [2]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.PMID 24909831
3. [3]Hyams J, Crandall W, Kugathasan S, Griffiths A, Olson A, Johanns J, et al Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children. Gastroenterology, 2007.PMID 17324398
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6. [6]Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, de Carpi JM, Bronsky J, et al Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis-An Evidence-based Consensus Guideline From the European Crohn's and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr, 2018.PMID 30044358
7. [7]Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, de Carpi JM, Bronsky J, et al Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr, 2018.PMID 30044357
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9. [9]Hyams JS, Griffiths A, Markowitz J, Baldassano RN, Faubion WA Jr, Colletti RB, et al Safety and efficacy of adalimumab for moderate to severe Crohn's disease in children. Gastroenterology, 2012.PMID 22562021
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11. [11]Ruemmele FM, Hyams JS, Otley A, Griffiths A, Kolho KL, Dias JA, et al Outcome measures for clinical trials in paediatric IBD: an evidence-based, expert-driven practical statement paper of the paediatric ECCO committee. Gut, 2015.PMID 24821616
12. [12]Faubion WA, Dubinsky M, Ruemmele FM, Escher J, Rosh J, Hyams JS, et al Long-term Efficacy and Safety of Adalimumab in Pediatric Patients with Crohn's Disease. Inflamm Bowel Dis, 2017.PMID 28129288