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  • Review Article
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Advances in the medical management of paediatric IBD

Nature Reviews Gastroenterology & Hepatology volume 11, pages 99–108 (2014)Cite this article

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Abstract

IBD includes two classic entities, Crohn's disease and ulcerative colitis, and a third undetermined form (IBD-U), characterized by a chronic relapsing course resulting in a high rate of morbidity and impaired quality of life. Children with IBD are vulnerable in terms of growth failure, malnutrition and emotional effects. The aims of therapy have now transitioned from symptomatic control to the achievement of mucosal healing and deep remission. This type of therapy has been made possible by the advent of disease-modifying drugs, such as biologic agents, which are capable of interrupting the inflammatory cascade underlying IBD. Biologic agents are generally administered in patients who are refractory to conventional therapies. However, there is growing support that such agents could be used in the initial phases of the disease, typically in paediatric patients, to interrupt and cease the inflammatory process. Until several years ago, most therapeutic programmes in paediatric patients with IBD were borrowed from adult trials, whereas paediatric studies were often retrospective and uncontrolled. However, guidelines on therapeutic management of paediatric IBD and controlled, prospective, randomized trials including children with IBD have now been published. Here, the current knowledge concerning treatment options for children with IBD are reported. We also highlight the effectiveness and safety of new therapeutic advances in these paediatric patients.

Key Points

  • Paediatric IBD often presents with a more severe phenotype and course than the adult-onset disease

  • Current therapeutic goals for paediatric IBD have evolved from symptomatic control towards the achievement of mucosal healing and deep remission

  • Advances in our understanding of the immunobiology of IBD have led to the discovery of biologic agents; using biologic agents as disease-modifying drugs in early IBD might induce disease stabilization and limit its progression

  • The aggressive nature and the evolution of IBD in childhood and its consequent metabolic effects make biologic agents an attractive option for many paediatric patients with IBD

  • Widely agreed data indicate that biologic agents in paediatric IBD facilitate mucosal healing and improve growth and quality of life by achieving steroid-sparing remission

  • Improved understanding of the mechanisms of paediatric IBD will lead to a recognition of which patients might most benefit from early use of biologic agents

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Figure 1: Therapeutic pyramid for paediatric IBD.

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Authors and Affiliations

  1. Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy

    Marina Aloi, Federica Nuti & Salvatore Cucchiara

  2. Department of Radiobiology and Human Health, ENEA (National Agency for Energy, New Technologies and Environment), Via Anguillarese 301, Rome, 00123, Italy

    Laura Stronati

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  1. Marina Aloi
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  2. Federica Nuti
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All authors contributed equally to all aspects of the manuscript.

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Correspondence to Salvatore Cucchiara.

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Supplementary information

Supplementary Box 1

Adverse effects of systemic corticosteroids (DOC 37 kb)

Supplementary Box 2

Adverse effects of thiopurines (DOC 37 kb)

Supplementary Box 3

Adverse effects of methotrexate (DOC 37 kb)

Supplementary Box 4

Adverse effects related to biologic therapy (DOC 37 kb)

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Aloi, M., Nuti, F., Stronati, L. et al. Advances in the medical management of paediatric IBD. Nat Rev Gastroenterol Hepatol 11, 99–108 (2014). https://doi.org/10.1038/nrgastro.2013.158

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