Pediatric Inflammatory Bowel Disease: New Frontiers in Diagnosis and Treatment

 This article is based on the recent scientific review “Inflammatory bowel disease: recent developments,” published in 2024 in the journal Archives of Disease in Childhood by Professor James John Ashton and Professor R. Mark Beattie. The authors are leading experts in pediatric gastroenterology and genetics affiliated with Southampton Children’s Hospital and the University of Southampton, United Kingdom.

In their review, they examine the latest advancements in the diagnosis, treatment, and long-term management of inflammatory bowel disease (IBD) in children and adolescents. Drawing on their analysis, we present several key questions and answers that directly relate to the daily care, challenges, and outlook for patients living with this chronic illness.

“Caring for children with inflammatory bowel disease is entering a new era—one marked by more precise diagnosis, personalized therapy, and a multidisciplinary approach that brings new hope for patients and their families.”

Expert Insights

In recent years, the field of pediatric inflammatory bowel disease (IBD)—including Crohn’s disease and ulcerative colitis—has undergone a true revolution in both diagnosis and treatment. The development of new diagnostic tools, biomarkers, and personalized approaches, along with the emergence of advanced medications, has placed patients and their families at the center of increasingly precise, multidisciplinary care. In this article, we present five key expert insights and scientific quotes from the 2024 review that will help patients, their loved ones, and healthcare professionals understand current trends and best practices in this rapidly evolving field.

1. IBD is Becoming an Epidemic Among Children: Implications for Diagnosis and Care

Q: Why are more children being diagnosed with inflammatory bowel disease, and what impact does this have on healthcare systems?

“The rapid and sustained increase in paediatric-onset inflammatory bowel disease (IBD) incidence has significant impact for service provision and planning.”

Explanation: Over the past 25 years, cases of pediatric IBD have doubled. The rise is thought to be due more to environmental factors—such as changes in diet, the “hygiene hypothesis” (less microbial exposure in early childhood), and better diagnostic tools—than to genetic shifts. This surge requires healthcare systems to adapt with increased resources, specialized training, and dedicated teams to meet the needs of the growing pediatric IBD population.

2. Delays in Diagnosis Must Be Avoided: The Role of Fecal Calprotectin

Q: What is the most important non-invasive test for diagnosing and monitoring IBD in children?

“Correct use of faecal calprotectin (FCp) as a screening tool has the potential to prevent diagnostic delay in IBD. Red flags in the presence of relatively normal FCp should not delay referral.”

Explanation: Fecal calprotectin is a protein released by inflammatory cells in the intestines and measured in stool. Elevated levels suggest inflammation, but normal levels do not rule out IBD—especially in young children or cases involving only the small intestine. This test is extremely useful for early diagnosis and monitoring treatment progress, but it must always be interpreted alongside symptoms and other lab results.

3. Genetics and Personalized Medicine Are Now a Reality

Q: Is genetic testing worthwhile in children with IBD?

“Prediction and personalisation of management in IBD is coming, with current elements such as therapeutic drug monitoring and genomic testing for monogenic forms of disease likely to be joined by clinical and molecular biomarkers of response and outcome.”

Explanation: Although monogenic (single-gene) forms of IBD are rare (under 0.5% of pediatric cases), identifying them can dramatically change the treatment approach—including options like stem cell transplantation or targeted medications. Genetic testing also helps families with a known hereditary risk and may guide individualized treatment strategies.

4. Diet: Myths, Realities, and the Future

Q: How important is diet in treating pediatric IBD?

“Despite the interest in diet and dietary manipulation in IBD, no ‘normal’ food diet has significant evidence of efficacy in inducing remission... However, this does not equate to dietary therapy being an unviable future option for treatment.”

Explanation: Despite the popularity of diets like FODMAP, Mediterranean, or vegetarian, none have proven effective in inducing remission in IBD. The only approach with solid evidence, especially for Crohn’s disease, is exclusive enteral nutrition (EEN)—a liquid diet using specialized formulas. That said, personalized nutrition is gaining momentum and is expected to play a growing role in future treatment plans.

5. Modern Treatments: From Traditional Drugs to Biologics and Small Molecules

Q: What are the latest trends in drug therapy for pediatric IBD?

“The availability of newer treatments, including biological and small molecular therapies, will allow diversification of management. Combining contemporary medicines, with prediction of response, will improve clinical outcomes.”

Explanation: In the past decade, traditional immunosuppressants and steroids have been supplemented with biologics (such as anti-TNF agents and IL-12/23 inhibitors) and small-molecule drugs that target specific immune pathways. With tools like therapeutic drug monitoring (measuring drug levels in the blood), treatment is becoming more personalized, aiming for better outcomes with fewer side effects.

Q&A

1. How long does it take to get diagnosed, and why is diagnosis sometimes delayed?

Answer: Unfortunately, many IBD patients experience months or even years of delays before being referred to a specialist and undergoing the endoscopy and biopsy required for diagnosis. Reasons include atypical or fluctuating symptoms, normal inflammatory markers in some cases, and under-recognition in children with family history—where a lower threshold for suspicion is warranted.

2. What are the current diagnostic tools for IBD, and why are they important?

Answer: Today, diagnosis and monitoring rely on a combination of tests: upper and lower endoscopy with biopsies, imaging techniques like magnetic resonance enterography, and newer tools like video capsule endoscopy. Capsule endoscopy is safe even for children as young as 2 years old and allows for more accurate assessment of disease spread. Ultrasound imaging of the small intestine is also evolving and can be used even in outpatient settings.

3. Is there a difference between Crohn’s disease and ulcerative colitis in children?

Answer: Traditionally, Crohn’s and ulcerative colitis are distinguished by the location of inflammation and certain histological features. However, the boundaries between them are increasingly blurred. Experts now talk about an “IBD continuum,” where treatment is guided by disease severity, location, progression, and additional factors—rather than rigid definitions.

4. What are the modern approaches to monitoring and controlling the disease?

Answer: After diagnosis, various methods are used to track inflammation and treatment response, including fecal calprotectin (to assess inflammation), blood tests, imaging, and repeat endoscopy. Remote collection and mailing of stool samples for calprotectin testing is also available, making it easier for patients and enabling early detection of flare-ups.

5. How is the best treatment plan determined, and what is the role of a multidisciplinary team?

Answer: Treatment decisions are based on the individual patient—considering disease severity, risk factors, inflammation location, and any genetic findings. Today, care is delivered by specialized multidisciplinary teams including doctors, nurses, dietitians, psychologists, and pharmacists. This allows for tailored treatment plans, home-based medication when possible, and remote monitoring to better support the child and their family.

Conclusion 

The publication by Ashton and Beattie clearly shows that care for children with inflammatory bowel disease is entering a new era—characterized by personalized treatment, more accurate diagnosis, multidisciplinary collaboration, and an expanding range of therapeutic options. While challenges remain—including delays in diagnosis and the need for individualized care—modern science and clinical practice offer new hope for better disease control and improved quality of life for young patients with IBD.

This article, based entirely on the analysis and recommendations of the British experts, aims to provide accessible, evidence-based information tailored to the needs of patients and their families.

Source: Ashton JJ, Beattie RM. Inflammatory bowel disease: recent developments. Arch Dis Child 2024;109:370–376. doi:10.1136/archdischild-2023-325668