A narrative review of pitfall and progress in management of inflammatory bowel disease in children

Abstract

Background and Objective: Inflammatory bowel diseases (IBDs) broadly classified as ulcerative colitis (UC) and Crohn’s disease (CD), are progressive chronic intestinal disorders commonly diagnosed in the pediatric age group. Studies report 10–25% of IBD is diagnosed before 16 years of age. IBD in children is more aggressive, with more widespread involvement of ileum and colon and a higher disease burden compared to adult-onset IBD, despite greater immune-suppression use. While the immediate purpose of therapy in IBD is controlling symptoms and restoring good quality of life, long-term goals are preventing complications such as nutritional failure, stricture, fistula, hospitalization and surgery. The best long-term goals are achievable with tight monitoring strategies aiming for healing of intestinal mucosa in addition to controlling symptoms, also known as deep-remission. There has been phenomenal progress in IBD therapies, especially newer biologic agents and oral small synthetic molecules. These newer generations of drugs are safer, less immunogenic and also capable of inducing deep healing. However, despite rapidly expanding treatment paradigms in the management of IBD, integrated care to optimize diet, nutrition, psychological well-being is a crucial long-term goal. The main purpose of this narrative review is to provide a contemporary overview of the IBD in children, with a focus on common pitfalls and progress in the modern management of pediatric IBD.