Inflammatory bowel disease in children: current trends

Abstract

Once considered rare in the East, inflammatory bowel disease (IBD) is now recognized to be an emerging entity in that region. East or West, the clinical features of and treatment options for IBD are the same, but it is possible that the exact pathogeneses or the initiating events differ. In this review, existing knowledge of IBD and new discoveries in the epidemiology, genetics and treatment of IBD are discussed in detail. The diagnosis and management of IBD in children has changed dramatically over the last decade, mainly due to increased awareness, the availability of newer diagnostic modalities such as MRI and video capsule endoscopy, and newer, more powerful treatments such as biologics. It is hoped that the combination of innovative research and advances in drug discoveries will change the natural history of IBD and make a major difference in children who are suffering from this unfortunate lifelong chronic inflammatory disorder.

Peroxisome Proliferator-activated Receptor-γ Coactivator 1-α (PGC1α) Protects against Experimental Murine Colitis

“…States (1)(2)(3). In 2008, the direct costs associated with the disease exceeded 6.8 billion dollars (4), and furthermore, the worldwide prevalence of IBD appears to be increasing (5).…”

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

“…More recent basic and clinical research indicates that the chronic inflammatory reaction of the intestinal mucosa is directed against the gut microbiota in individuals with genetic and/or environmental susceptibilities. Disease onset occurs typically during young adulthood (25-35 yr), although ϳ20 -25% of cases are diagnosed during childhood (93). On a clinical basis, two major subtypes of IBD are defined as Crohn's disease (CD), which potentially affects any part of the gastrointestinal tract from the mouth to the anus, and ulcerative colitis (UC), an inflammatory condition limited to the colonic mucosa.…”

“…Pediatric IBD patients form a separate group not only because of distinct disease characteristics and perhaps distinct genetic predispositions (93), but also because of differences in their bone metabolism. During the prepubescent and early pubescent period, bone modeling is the predominant form of skeletal growth, and the activities of osteoblasts and osteoclasts are not coupled.…”

Imaging of the small bowel: Crohn’s disease in paediatric patients

“…Although the exact frequency of the small bowel (SB) CD is unknown, most gastroenterologists believe that its prevalence has been underestimated and that it may have an increased incidence among children and young adolescents [2] . A recent study performed in pediatric patients with magnetic resonance (MR) enterography [3] , according to previous studies [4] , confirmed that the involvement of the terminal ileum is common to more than three times compared to that of the jejunum and the rest of the ileum. Moreover, the involvement of the jejunum alone is uncommon and it is more difficult to investigate because of its tendency to stay non distended [3] .…”

“…The clinical importance of the SB CD phenotype is the impact that a diffuse SB disease is expected to have on a child's growth and development. Moreover, patients with SB CD are more likely to experience complications, including intestinal obstruction and less commonly fistulization [4,5] . Thus, objective evaluation of the SB is essential in differentiating CD from other enteropathies and in directing the management of the patients with inflammatory bowel disease (IBD) [6,7] .…”