儿童炎症性肠病的研究现状及展望

doi:10.12372/jcp.2023.23e0957

Abstract

Abstract:

Pediatric inflammatory bowel disease (PIBD) refers to a group of chronic and recurrent intestinal inflammatory diseases with unidentified cause. The complexity of its pathogenesis presents ongoing challenges in diagnosis and treatment. In recent years, there has been a noticeable increase in the prevalence of IBD among children both domestically and internationally, which has aroused widespread concern among pediatricians. This article aims to provide a comprehensive overview of the pathogenesis in pediatric IBD, a turbo-charged treat to target strategy in IBD, as well as the transition of management in adolescents with IBD. Its findings can serve as a valuable reference for Chinese pediatricians engaged in IBD research.

Key words: pediatric, inflammatory bowel disease, pathogenesis, treat to target, transition of management

WU Jie, ZHANG Tianzhuo. An analysis of the present status and future prospects of pediatric inflammatory bowel disease[J].Journal of Clinical Pediatrics, 2023, 41(11): 801-807.

References 49

[1]	Ruemmele FM, Veres G, Kolho KL, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease[J]. J Crohns Colitis, 2014, 8(10): 1179-1207. doi: 10.1016/j.crohns.2014.04.005 pmid: 24909831
[2]	Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis, part 1: ambulatory care-an evidence-based guideline from European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2018, 67(2): 257-291. doi: 10.1097/MPG.0000000000002035
[3]	Birimberg-Schwartz L, Zucker DM, Akriv A, et al. Development and validation of diagnostic criteria for IBD subtypes including IBD-unclassified in children: a multicentre study from the pediatric IBD Porto group of ESPGHAN[J]. J Crohns Colitis, 2017, 11(9): 1078-1084. doi: 10.1093/ecco-jcc/jjx053 pmid: 28430891
[4]	Benchimol EI, Fortinsky KJ, Gozdyra P, et al. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends[J]. Inflamm Bowel Dis, 2011, 17(1): 423-439. doi: 10.1002/ibd.21349 pmid: 20564651
[5]	Kuenzig ME, Fung SG, Marderfeld L, et al. Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review[J]. Gastroenterology, 2022, 162(4): 1147-1159. doi: 10.1053/j.gastro.2021.12.282 pmid: 34995526
[6]	Windsor JW, Buie M, Coward S, et al. A28 relative rates of ulcerative colitis to Crohn’s disease: parallel epidemiologies in newly vs. highly industrialized countries[J]. Journal of the Canadian Association of Gastroenterology, 2020, 3(Supplement_1): 34-35.
[7]	Kugathasan S, Baldassano RN, Bradfield JP, et al. Loci on 20q13 and 21q22 are associated with pediatric-onset inflammatory bowel disease[J]. Nat Genet, 2008, 40(10): 1211-1215. doi: 10.1038/ng.203 pmid: 18758464
[8]	Muise AM, Snapper SB, Kugathasan S. The age of gene discovery in very early onset inflammatory bowel disease[J]. Gastroenterology, 2012, 143(2): 285-288. doi: 10.1053/j.gastro.2012.06.025 pmid: 22727850
[9]	Bequet E, Sarter H, Fumery M, et al. Incidence and phenotype at diagnosis of very-early-onset compared with later-onset paediatric inflammatory bowel disease: a population-based study [1988-2011][J]. J Crohns Colitis, 2017, 11(5): 519-526. doi: 10.1093/ecco-jcc/jjw194 pmid: 28453757
[10]	Ong C, Aw MM, Liwanag MJ, et al. Rapid rise in the incidence and clinical characteristics of pediatric inflammatory bowel disease in a South-East Asian cohort in Singapore, 1994-2015[J]. J Dig Dis, 2018, 19(7): 395-403. doi: 10.1111/cdd.2018.19.issue-7
[11]	Turpin W, Goethel A, Bedrani L, et al. Determinants of IBD heritability: genes, bugs, and more[J]. Inflamm Bowel Dis, 2018, 24(6): 1133-1148. doi: 10.1093/ibd/izy085 pmid: 29701818
[12]	Suarez RG, Osornio-Vargas AR, Wine E. Ambient air pollution and pediatric inflammatory bowel diseases: an updated scoping review[J]. Dig Dis Sci, 2022, 67(9): 4342-4354. doi: 10.1007/s10620-022-07597-3
[13]	Forbes JD, Van Domselaar G, Bernstein CN. Microbiome survey of the inflamed and noninflamed gut at different compartments within the gastrointestinal tract of inflammatory bowel disease patients[J]. Inflamm Bowel Dis, 2016, 22(4): 817-825. doi: 10.1097/MIB.0000000000000684 pmid: 26937623
[14]	Parada Venegas D, De la Fuente MK, Landskron G, et al. Corrigendum: short chain fatty acids (SCFAs)-mediated gut epithelial and immune regulation and its relevance for inflammatory bowel diseases[J]. Front Immunol, 2019, 10: 1486. doi: 10.3389/fimmu.2019.01486 pmid: 31316522
[15]	Di Vincenzo F, Puca P, Lopetuso LR, et al. Bile acid-related regulation of mucosal inflammation and intestinal motility: from pathogenesis to therapeutic application in IBD and microscopic colitis[J]. Nutrients, 2022, 14(13): 2664. doi: 10.3390/nu14132664
[16]	Kurilshikov A, Wijmenga C, Fu J, et al. Host genetics and gut microbiome: challenges and perspectives[J]. Trends Immunol, 2017, 38(9): 633-647. doi: S1471-4906(17)30106-0 pmid: 28669638
[17]	Flannigan KL, Geem D, Harusato A, et al. Intestinal antigen-presenting cells: key regulators of immune homeostasis and inflammation[J]. Am J Pathol, 2015, 185(7): 1809-1819. doi: 10.1016/j.ajpath.2015.02.024 pmid: 25976247
[18]	Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: an update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the international organization for the study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD[J]. Gastroenterology, 2021, 160(5): 1570-1583. doi: 10.1053/j.gastro.2020.12.031 pmid: 33359090
[19]	Plevris N, Lees CW. Disease monitoring in inflammatory bowel disease: evolving principles and possibilities[J]. Gastroenterology, 2022, 162(5): 1456-1475. doi: 10.1053/j.gastro.2022.01.024
[20]	Kuharic M, Krugliak Cleveland N, Candela N, et al. P042 Early versus later use of vedolizumab In IBD: patient characteristics and treatment patterns in the real world (RALEE)[J]. Am J Gastroenterol, 2021, 116(Suppl 1): S11. doi: 10.14309/01.ajg.0000798768.43978.95 pmid: 34848629
[21]	Feuerstein JD, Nguyen GC, Kupfer SS, et al. American gastroenterological association institute guideline on therapeutic drug monitoring in inflammatory bowel disease[J]. Gastroenterology, 2017, 153(3): 827-834. doi: S0016-5085(17)35963-2 pmid: 28780013
[22]	Hyams J, Crandall W, Kugathasan S, et al. Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children[J]. Gastroenterology, 2007, 132(3): 863-873. doi: 10.1053/j.gastro.2006.12.003 pmid: 17324398
[23]	Hyams J, Damaraju L, Blank M, et al. Induction and maintenance therapy with infliximab for children with moderate to severe ulcerative colitis[J]. Clin Gastroenterol Hepatol, 2012, 10(4): 391-399. doi: 10.1016/j.cgh.2011.11.026
[24]	Papamichael K, Afif W, Drobne D, et al. Therapeutic drug monitoring of biologics in inflammatory bowel disease: unmet needs and future perspectives[J]. Lancet Gastroenterol Hepatol, 2022, 7(2): 171-185. doi: 10.1016/S2468-1253(21)00223-5
[25]	Vvan Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn's disease: an ECCO-ESPGHAN guideline update[J]. J Crohns Colitis, 2020-jjaa161.
[26]	Cheifetz AS, Abreu MT, Afif W, et al. A comprehensive literature review and expert consensus statement on therapeutic drug monitoring of biologics in inflammatory bowel disease[J]. Am J Gastroenterol, 2021, 116(10): 2014-2025. doi: 10.14309/ajg.0000000000001396 pmid: 34388143
[27]	Venkatesh K, Cohen M, Evans C, et al. Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders[J]. World J Gastroenterol, 2009, 15(18): 2214-2219. doi: 10.3748/wjg.15.2214
[28]	Miele E, Shamir R, Aloi M, et al. Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the Porto inflammatory bowel disease group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2018, 66(4): 687-708. doi: 10.1097/MPG.0000000000001896
[29]	Bischoff SC, Bager P, Escher J, et al. ESPEN guideline on clinical nutrition in inflammatory bowel disease[J]. Clin Nutr, 2023, 42(3): 352-379. doi: 10.1016/j.clnu.2022.12.004 pmid: 36739756
[30]	Sarbagili-Shabat C, Albenberg L, Van Limbergen J, et al. A novel UC exclusion diet and antibiotics for treatment of mild to moderate pediatric ulcerative colitis: a prospective open-label pilot study[J]. Nutrients, 2021, 13(11): 3736. doi: 10.3390/nu13113736
[31]	Radziszewska M, Smarkusz-Zarzecka J, Ostrowska L, et al. Nutrition and supplementation in ulcerative colitis[J]. Nutrients, 2022, 14(12): 2469. doi: 10.3390/nu14122469
[32]	Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis, part 2: acute severe colitis-an evidence-based consensus guideline from the European Crohn's and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2018, 67(2): 292-310. doi: 10.1097/MPG.0000000000002036
[33]	Nakase H, Uchino M, Shinzaki S, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease 2020[J]. J Gastroenterol, 2021, 56(6): 489-526. doi: 10.1007/s00535-021-01784-1 pmid: 33885977
[34]	Atia O, Shavit-Brunschwig Z, Mould DR, et al. Outcomes, dosing, and predictors of vedolizumab treatment in children with inflammatory bowel disease (VEDOKIDS): a prospective, multicentre cohort study[J]. Lancet Gastroenterol Hepatol, 2023, 8(1): 31-42. doi: 10.1016/S2468-1253(22)00307-7
[35]	Singh N, Rabizadeh S, Jossen J, et al. Multi-center experience of vedolizumab effectiveness in pediatric inflammatory bowel disease[J]. Inflamm Bowel Dis, 2016, 22(9): 2121-6. doi: 10.1097/MIB.0000000000000865 pmid: 27542130
[36]	Dayan JR, Dolinger M, Benkov K, et al. Real world experience with ustekinumab in children and young adults at a tertiary care pediatric inflammatory bowel disease center[J]. J Pediatr Gastroenterol Nutr, 2019, 69(1): 61-67. doi: 10.1097/MPG.0000000000002362
[37]	Wlazło M, Kierkuś J. Dual biologic therapy for the treatment of pediatric inflammatory bowel disease: a review of the literature[J]. J Clin Med, 2022, 11(7).
[38]	Panés J, Loftus EV, Higgins PDR, et al. Induction and maintenance treatment with upadacitinib improves health-related quality of life in patients with moderately to severely active ulcerative colitis: phase 3 study results[J]. Inflamm Bowel Dis, 2023, 29(9): 1421-1430. doi: 10.1093/ibd/izac260
[39]	D'Haens G, Panés J, Louis E, et al. Upadacitinib was efficacious and well-tolerated over 30 months in patients with Crohn's disease in the celest extension study[J]. Clin Gastroenterol Hepatol, 2022, 20(10): 2337-2346.. doi: 10.1016/j.cgh.2021.12.030
[40]	Collen LV. Rapid clinical remission with upadacitinib in a pediatric patient with refractory Crohn's disease[J]. Inflamm Bowel Dis, 2023, 29(7): 1175-1176. doi: 10.1093/ibd/izad048
[41]	Moore H, Dubes L, Fusillo S, et al. Tofacitinib therapy in children and young adults with pediatric-onset medically refractory inflammatory bowel disease[J]. J Pediatr Gastroenterol Nutr, 2021, 73(3): e57-e62. doi: 10.1097/MPG.0000000000003190
[42]	Kassam Z, Lee CH, Yuan Y, et al. Fecal microbiota transplantation for clostridium difficile infection: systematic review and meta-analysis[J]. Am J Gastroenterol, 2013, 108(4): 500-508. doi: 10.1038/ajg.2013.59 pmid: 23511459
[43]	黄瑛, 王玉环. 粪菌移植治疗儿童炎症性肠病[J]. 中华实用儿科临床杂志, 2017, 32(7): 491-493.
[44]	Tan P, Li X, Shen J, et al. Fecal microbiota transplantation for the treatment of inflammatory bowel disease: an update[J]. Front Pharmacol, 2020, 11: 574533. doi: 10.3389/fphar.2020.574533
[45]	Reider S, Binder L, Fürst S, et al. Hematopoietic stem cell transplantation in refractory Crohn's disease: should it be considered?[J]. Cells, 2022, 11(21): 3436. doi: 10.3390/cells11213436
[46]	Liang J, Zhang H, Wang D, et al. Allogeneic mesenchymal stem cell transplantation in seven patients with refractory inflammatory bowel disease[J]. Gut, 2012, 61(3): 468-469. doi: 10.1136/gutjnl-2011-300083 pmid: 21617158
[47]	Bollegala N, Brill H, Marshall JK. Resource utilization during pediatric to adult transfer of care in IBD[J]. J Crohns Colitis, 2013, 7(2): e55-60. doi: 10.1016/j.crohns.2012.05.010
[48]	Menon T, Afzali A. Inflammatory bowel disease: a practical path to transitioning from pediatric to adult care[J]. Am J Gastroenterol, 2019, 114(9): 1432-1440. doi: 10.14309/ajg.0000000000000222 pmid: 30985298
[49]	Sexton KA, Walker JR, Graff LA, et al. Evidence of bidirectional associations between perceived stress and symptom activity: a prospective longitudinal investigation in inflammatory bowel disease[J]. Inflamm Bowel Dis, 2017, 23(3): 473-483. doi: 10.1097/MIB.0000000000001040 pmid: 28221251

An analysis of the present status and future prospects of pediatric inflammatory bowel disease

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

References 49

Related Articles 15

Metrics

Comments

Recommended 0

[1]	JIA Shichen, XU Guofeng. Advances in the diagnosis and treatment of cystinuria [J]. Journal of Clinical Pediatrics, 2026, 44(8): 740-746.
[2]	DING Qiuyuan, ZHOU Liang. Research progress of pediatric intensive care unit-acquired weakness [J]. Journal of Clinical Pediatrics, 2026, 44(8): 755-762.
[3]	GU Siyi, XU Mingyu, LI Fei. Application of motivational interviewing in the management of pediatric and adolescent diseases [J]. Journal of Clinical Pediatrics, 2026, 44(5): 471-477.
[4]	ZHOU Yuanke, SUN Lina, FANG Ying. Research progress on the role of zinc in the occurrence, development and treatment of inflammatory bowel disease in children [J]. Journal of Clinical Pediatrics, 2026, 44(1): 64-70.
[5]	YAO Yunlu, XU Haixin, LIU Xinzhu, CHEN Jihui, BU Shuhong. Clinical practice and challenges of model-informed precision dosing with vancomycin in pediatrics [J]. Journal of Clinical Pediatrics, 2026, 44(1): 84-90.
[6]	CHANG Ya, ZHOU Yunqing, WANG Jiwen, WU Hongyan, YANG Fangfei, SUN Lina. Treatment of congenital myotonia: a case series of 3 pediatric patients [J]. Journal of Clinical Pediatrics, 2025, 43(9): 692-697.
[7]	ZHOU Zhixuan, WANG Ying. Application progress of glucagon-like peptide-2 analogues in inflammatory bowel disease [J]. Journal of Clinical Pediatrics, 2025, 43(9): 716-722.
[8]	LYU Mingjun, LUO Wen, YANG Jinxiang, LIANG Jianying, YAO Zhirong. Progress in pathogenesis and treatment of pediatric generalized pustular psoriasis [J]. Journal of Clinical Pediatrics, 2025, 43(7): 556-562.
[9]	XU Shiyi, DU Min, BAI Lixia, LIU Aihong. Research progress on severe pertussis in infants and young children [J]. Journal of Clinical Pediatrics, 2025, 43(5): 383-388.
[10]	CHENG Siyi, WU Xiushu. Progress of intravenous thrombolysis in pediatric acute ischemic stroke [J]. Journal of Clinical Pediatrics, 2025, 43(4): 318-322.
[11]	JIA Shuangzhen, KONG Yan, LIU Qian-chao, ZHU Ailin, WU Jie. Application of precision therapy in pediatric inflammatory bowel disease [J]. Journal of Clinical Pediatrics, 2025, 43(3): 226-232.
[12]	TIAN Enxia, GUO Lining, LIU Shanshan, ZHANG Jie. Study on the correlation between the physicochemical properties of effusion in otitis media with effusion and the expression levels of oxidative stress-related enzymes in children [J]. Journal of Clinical Pediatrics, 2025, 43(12): 928-932.
[13]	ZHANG Yunhui, SHI Huijing, ZHAI Xiaowen. The Shanghai Maternal-Child Pairs Cohort (MCPC) and its application in clinical research [J]. Journal of Clinical Pediatrics, 2024, 42(9): 758-767.
[14]	GUO Jiaying, ZHOU Zijing, LI Yaohua. Supervision status and clinical research of pediatric medical devices in China and the United States [J]. Journal of Clinical Pediatrics, 2024, 42(9): 822-826.
[15]	KANG Li, HUANG Jiaoling. The impact of infectious disease outbreaks on the pediatric healthcare system and countermeasures [J]. Journal of Clinical Pediatrics, 2024, 42(6): 475-479.