Treating children with inflammatory bowel disease: Current and new perspectives

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gut characterised by alternating periods of remission and relapse. Whilst the mechanism underlying this disease is yet to be fully understood, old and newer generation treatments can only target selected pathways of this complex inflammatory process. This narrative review aims to provide an update on the most recent advances in treatment of paediatric IBD. A MEDLINE search was conducted using “paediatric inflammatory bowel disease”, “paediatric Crohn’s disease”, “paediatric ulcerative colitis”, “treatment”, “therapy”, “immunosuppressant”, “biologic”, “monitoring” and “biomarkers” as key words. Clinical trials, systematic reviews, and meta-analyses published between 2014 and 2016 were selected. Studies referring to earlier periods were also considered in case the data was relevant to our scope. Major advances have been achieved in monitoring the individual metabolism, toxicity and response to relevant medications in IBD including thiopurines and biologics. New biologics acting on novel mechanisms such as selective interference with lymphocyte trafficking are emerging treatment options. Current research is investing in the development of reliable prognostic biomarkers, aiming to move towards personalised treatments targeted to individual patients.

Immunosuppressive therapy in childhood‐onset arrhythmogenic inflammatory cardiomyopathy

“…Treatment regimen was derived from adult patients with autoimmune myocarditis 2,7 and adapted to pediatric doses as in other immune-mediated diseases of childhood. 8,9 Overall, IST was safe and well tolerated. In addition, multiple beneficial effects were documented following treatment onset (Figure 3).…”

“…Both the patient and his parents were actively involved in the discussion about the risk‐to‐benefit ratio, and time was needed before they accepted the indication to IST. Treatment regimen was derived from adult patients with autoimmune myocarditis 2,7 and adapted to pediatric doses as in other immune‐mediated diseases of childhood 8,9 . Overall, IST was safe and well tolerated.…”

Inflammatory Bowel Disease: A Personalized Approach

“…The burden of disease can be modified by treatment, but in principle, IBD presents with relapsing and remitting course throughout life ( 4 ). CD and UC, while sharing several similar pathologic and clinical features, have distinct differences in prognosis and management ( 5 ). Disease type and distribution in part influence disease progression and prognosis ( 6 , 7 ).…”

Rab27A promotes cellular apoptosis and ROS production by regulating the miRNA‐124‐3p/STAT3/RelA signalling pathway in ulcerative colitis

“…Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects both children and adults, and is characterized by periods of relapse followed by periods of remission. 1 Because of the westernized dietary lifestyle, the incidence of UC in several Asian countries, especially in China, is rising rapidly. 2,3 However, although dysregulation in intestinal epithelial cells, such as TNF-α and IL-1β, 4,5 has been widely reported in UC, the molecular basis and pathophysiology of UC are not completely understood.…”

“…Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects both children and adults, and is characterized by periods of relapse followed by periods of remission 1 . Because of the westernized dietary lifestyle, the incidence of UC in several Asian countries, especially in China, is rising rapidly 2,3 .…”