Expert consensus on diagnostic guidelines for pediatric inflammatory bowel disease in Japan

Takahiro Kudo¹, Katsuhiro Arai², Itaru Iwama³, Shin-Ichiro Hagiwara⁴, Takashi Ishige⁵, Koji Yokoyama⁶, Fumihiko Kakuta⁷, Keisuke Jimbo⁸, Hiroki Kondou⁹, Yugo Takaki¹⁰, Shingo Kurasawa¹¹, Hiroki Fujikawa¹², Yuhki Koike¹³, Fumihito Hirai¹⁴, Shinya Ashizuka¹⁴, Kenji Watanabe¹⁵, Toshiaki Shimizu⁸, Tadakazu Hisamatsu¹⁶

Affiliations

¹ Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. t-kudo@juntendo.ac.jp.
² Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan.
³ Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.
⁴ Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan.
⁵ Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan.
⁶ Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan.
⁷ Department of Gastroenterology and Hepatology, Miyagi Children's Hospital, Sendai, Japan.
⁸ Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
⁹ Department of Pediatrics, Kindai University Nara Hospital, Nara, Japan.
¹⁰ Department of Pediatric Gastroenterology and Hepatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
¹¹ Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
¹² Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
¹³ Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
¹⁴ Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
¹⁵ Department of Internal Medicine for Inflammatory Bowel Disease, University of Toyama, Toyama, Japan.
¹⁶ Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.

PMID: 40603758
PMCID: PMC12378499
DOI: 10.1007/s00535-025-02271-7

Review

Expert consensus on diagnostic guidelines for pediatric inflammatory bowel disease in Japan

Takahiro Kudo et al. J Gastroenterol. 2025 Sep.

. 2025 Sep;60(9):1118-1144.

doi: 10.1007/s00535-025-02271-7. Epub 2025 Jul 2.

Authors

Affiliations

¹ Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. t-kudo@juntendo.ac.jp.
² Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan.
³ Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.
⁴ Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan.
⁵ Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan.
⁶ Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan.
⁷ Department of Gastroenterology and Hepatology, Miyagi Children's Hospital, Sendai, Japan.
⁸ Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
⁹ Department of Pediatrics, Kindai University Nara Hospital, Nara, Japan.
¹⁰ Department of Pediatric Gastroenterology and Hepatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
¹¹ Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
¹² Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
¹³ Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
¹⁴ Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
¹⁵ Department of Internal Medicine for Inflammatory Bowel Disease, University of Toyama, Toyama, Japan.
¹⁶ Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.

PMID: 40603758
PMCID: PMC12378499
DOI: 10.1007/s00535-025-02271-7

Abstract

Background: Inflammatory bowel disease (IBD) can occur at any age. In pediatric patients, the disease may present with a broader range of symptoms and more severe course than in adults, due to ongoing growth and development. Therefore, pediatric IBD often exhibits an atypical clinical course and laboratory findings. It is essential to recognize differences in disease presentation, differential diagnoses, and evaluation strategies specific to children. The revised Porto criteria, proposed by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) in 2014, are widely used globally, including in Japan, for the diagnosis of pediatric IBD.

Purpose: Despite the widespread use of these criteria, no formal diagnostic guidelines for pediatric IBD have been developed in Japan. We aimed to support future guideline development by summarizing important diagnostic considerations and clinical practices for pediatric IBD in Japan.

Methods: This review was developed based on relevant international diagnostic guidelines and the expert opinions of Japanese pediatric gastroenterologists. It outlines key clinical and laboratory evaluations, as well as current treatment and follow-up approaches.

Results: We summarized recommended diagnostic tests and clinical points that require special attention in children with suspected IBD. The article reflects both global standards and domestic clinical experience.

Conclusion: Although this article does not provide formal diagnostic criteria or assess evidence levels, it offers accurate and practical information to guide physicians and patients in the diagnosis and management of pediatric IBD in Japan.

Keywords: Children; Crohn’s disease; Inflammatory bowel disease; Pediatric; Ulcerative colitis.

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Conflict of interest statement

Declarations. Conflict of interest: Takashi Ishige received a consulting fee from AbbVie GK. Keisuke Jimbo received a grant Japan Society for the Promotion of Science KANENHI Grant-in-Aid for Scientific Research (c) [grant number 23K07361]. Fumihito Hirai received a consulting fee from AbbVie GK, EA pharma Co. Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Co. Ltd., Eli Lilly Japan K.K., MSD Co. Ltd., and a grant support from AbbVie GK, EA pharma Co. Ltd., Kyorin Pharmaceutical Co. Ltd., Mochida Pharmaceutical Co. Ltd.. Kenji Watanabe received a lecture fee from Takeda Pharmaceutical Co. Ltd., AbbVie GK, EA pharma Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co. Ltd., JIMRO Co. Ltd.. Toshiaki Shimizu received a research grant from The Food Science Institute Foundation (Ryoshoku-kenkyukai). Tadakazu Hisamatsu received a grant support from Mitsubishi Tanabe Pharma Corporation, EA pharma Co. Ltd., AbbVie GK, JIMRO Co. Ltd., Zeria Pharmaceutical Co. Ltd., Kyorin Pharmaceutical Co. Ltd., Nippon Kayaku Co. Ltd., Takeda Pharmaceutical Co. Ltd., Pfizer Inc., Mochida Pharmaceutical Co. Ltd., Boston Scientific Corporation, Kissei Pharmaceutical Co. Ltd., a consulting fee from Mitsubishi Tanabe Pharma Corporation, EA pharma Co. Ltd., AbbVie GK, Janssen Pharmaceutical K.K., Pfizer Inc., Eli Lilly, Gilead Sciences, Bristol Myers Squibb, Abivax, and a lecture fee from Mitsubishi Tanabe Pharma Corporation, AbbVie GK, EA pharma Co. Ltd., Kyorin Pharmaceutical Co. Ltd., JIMRO Co., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. Ltd., Pfizer Inc., Kissei Pharmaceutical Co. Ltd. All other authors declare no conflict of interest.

Figures

**Fig. 1**
Diagnostic flowchart of pediatric inflammatory bowel disease (IBD) proposed by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Because of the risk of capsule retention in children, small bowel patency should be evaluated using a patency capsule before attempting small bowel capsule endoscopy (SBCE). *BAE* balloon enteroscopy, CD Crohn’s disease, *IBD-U* inflammatory bowel disease unclassified, *MRE* magnetic resonance enterography, UC ulcerative colitis

**Fig. 2**
Algorithm of pediatric inflammatory bowel disease (IBD) classes used to determine the differential diagnosis of IBD subgroups. Adapted from [10], with partial modification. Upper row: number of applicable items among six features (no. 1–6 of class 1 of Table 4). Middle row: number of corresponding items among 12 features (no. 7–18 of class 2 of Table 4). Lower row: number of corresponding items among five features (no. 19–23 of class 3 of Table 4). CD Crohn’s disease, *IBD-U* inflammatory bowel disease unclassified, UC ulcerative colitis

**Fig. 3**
Schematic diagram of clinical manifestations, pathological mechanisms, and therapeutic interventions associated with pediatric inflammatory bowel disease (IBD)-related stunted growth. Evidence for all pathways has not been fully established. Adapted from [10], with partial modification. GH growth hormone, *IGF* insulin-like growth factor, IL interleukin, *QOL* quality of life, *TNF* tumor necrosis factor

See this image and copyright information in PMC

References

1. Matsuoka K, Kobayashi T, Ueno F, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol. 2018;53:305–13. - PMC - PubMed
1. Ishige T, Tomomasa T, Hatori R, et al. Temporal trend of pediatric inflammatory bowel disease: analysis of national registry data 2004 to 2013 in Japan. J Pediatr Gastroenterol Nutr. 2017;65:e80–2. - PubMed
1. Arai K, Kunisaki R, Kakuta F, et al. Phenotypic characteristics of pediatric inflammatory bowel disease in Japan: results from a multicenter registry. Intest Res. 2020;18:412–20. - PMC - PubMed
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1. Bolia R, Goel AD. Systematic review and meta-analysis of the frequency and re-classification trends of pediatric inflammatory bowel disease–unclassified. Arq Gastroenterol. 2022;59:531–9. - PubMed

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Expert consensus on diagnostic guidelines for pediatric inflammatory bowel disease in Japan

Affiliations

Expert consensus on diagnostic guidelines for pediatric inflammatory bowel disease in Japan

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Full Text Sources