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

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. Methods: While a systematic literature review is beyond the scope of this narrative overview. Peer reviewed articles based on hand searches from electronic database including PubMed, Medline and Google Scholar was carried out in December 2020. Peer reviewed articles published in English were selected based on citation index. Key Content and Findings: This review mainly includes articles specifically addressing diagnosis and management of IBD in children. However, seminal adult studies and authoritative articles from key opinion leaders of the field were also included to provide readers a flavor on recent progress. Conclusions: Treatment goals in IBD have been refined aiming for deeper remission. However, these goals can only be achieved by a prompt diagnosis, in-depth staging, early aggressive treatment selection, in those with high risk disease.