Considerations in Paediatric and Adolescent Inflammatory Bowel Disease.

Stephanie A Vuijk, Anouk E Camman, Lissy de Ridder
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Abstract

The incidence of inflammatory bowel disease [IBD] is rising most rapidly among children and adolescents. Paediatric-onset IBD is associated with a more extensive and severe disease course compared to adult-onset IBD. At a young age, screening for underlying genetic and immunological disorders is important and may impact treatment management. Early and effective treatment is crucial to reach disease remission and prevent complications of ongoing active disease. In children with Crohn's disease, exclusive enteral nutrition is an effective induction therapy. Other promising dietary therapies, such as the Crohn's disease exclusion diet, are emerging. Within paediatric IBD, anti-tumour necrosis factor therapy is the only approved biological thus far and additional treatment options are crucially needed. Other biological therapies, such as vedolizumab and ustekinumab, are currently prescribed off-label in this population. A specific challenge in paediatric IBD is the unacceptable and major delay in approval of drugs for children with IBD. A guided transfer period of paediatric patients to adult care is associated with improved disease outcomes and is required. Major knowledge gaps and challenges within paediatric IBD include the aetiology, diagnostics, and monitoring of disease, tailoring of treatment, and both understanding and coping with the physical and psychological consequences of living with IBD. Challenges and research gaps in paediatrics should be addressed without any delay in comparison with the adult field, in order to ensure a high quality of care for all patients with IBD, irrespective of the age of onset.

儿童和青少年炎症性肠病的注意事项。
炎症性肠病 [IBD] 的发病率在儿童和青少年中上升最快。与成人发病的 IBD 相比,儿童发病的 IBD 病程更长、病情更严重。在儿童年幼时,筛查潜在的遗传和免疫疾病非常重要,这可能会影响治疗管理。早期有效的治疗对于疾病缓解和预防活动性疾病并发症至关重要。对于克罗恩病患儿,完全肠内营养是一种有效的诱导疗法。其他有前景的饮食疗法,如克罗恩病排除饮食,也正在出现。在儿科 IBD 中,抗肿瘤坏死因子疗法是迄今为止唯一获得批准的生物疗法,因此亟需更多的治疗方案。其他生物疗法,如韦多珠单抗和乌司替珠单抗,目前在这一人群中属于非标签处方。儿童 IBD 所面临的一个特殊挑战是,用于儿童 IBD 的药物迟迟得不到批准,令人无法接受。儿科患者转入成人治疗的指导期与疾病预后的改善有关,因此需要进行指导。儿科 IBD 的主要知识差距和挑战包括疾病的病因、诊断和监测、针对性治疗,以及理解和应对 IBD 患者的生理和心理后果。与成人领域相比,儿科领域的挑战和研究差距应立即得到解决,以确保为所有 IBD 患者提供高质量的治疗,无论其发病年龄如何。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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