Inflammatory bowel disease: recent developments

Abstract

Paediatric-onset inflammatory bowel disease (IBD) is a complex and heterogenous condition. Incidence of disease in those aged <18 years has doubled over the last 25 years, with concurrent increased prevalence and no decrease in disease severity. The tools available at diagnosis for investigation have developed over the last 10 years, including better utilisation of faecal calprotectin, improved small bowel imaging and video capsule endoscopy. Alongside this, management options have increased and include biological and small molecule therapies targeting alternative pathways (such as interleukin 12/23, integrins and Janus kinase/signal transducers and activators of transcription, JAK-STAT pathways) and better understanding of therapeutic drug monitoring for more established agents, such as infliximab. Dietary manipulation remains an interesting but contentious topic.This review summarises some of the recent developments in the diagnosis, investigation and management of IBD in children and young people. IBD is increasingly recognised as a continuum of disease, with a proportion of patients presenting with classical Crohn's disease or ulcerative colitis phenotypes. Future implementation of personalisation and stratification strategies, including clinical and molecular biomarkers, implementation of predictors of response and outcome and use of additional therapies, will continue to require working within clinical networks and multiprofessional teams.

Keywords: Gastroenterology; Paediatrics.

Figure 1

Current (green) and future (orange) management aspects in paediatric-onset inflammatory bowel disease (IBD). Holistic care is important to improve outcomes, considering all aspects of the patient including psychological, education and social. 5-ASA, 5-aminosalicylic acid Figure created with https://www.biorender.com/

Figure 2

Disease aetiology in inflammatory bowel disease (IBD) is highly heterogenous—factors including genomic, epithelial function, bacterial and immunological function lead to significant heterogeneity in pathogenesis. There are likely to be numerous mechanisms at play within individuals, often leading to similar or related pathogenic phenotypes (represented by the blue text). There are now numerous therapeutic options for patients, although not all are available in paediatric practice yet. We have pointed to the mechanism of action of biologics and small molecule drugs (purple text). Figure created with biorender.com. IL, interleukin; TNF, tumour necrosis factor.