Current Progress in Pediatric Inflammatory Bowel Disease

Mini Review

J Fam Med. 2015;2(3): 1030.

Current Progress in Pediatric Inflammatory Bowel Disease

Zhenwu Lin*

Department of Pediatrics, Pennsylvania State University College of Medicine 500 University Drive, Department of Radiology, University of Pennsylvania Perelman School of Medicine, USA

*Corresponding author: Zhenwu Lin, Department of Pediatrics, Pennsylvania State University College of Medicine 500 University Drive, Department of Radiology, University of Pennsylvania Perelman School of Medicine, USA

Received: March 24, 2015; Accepted: May 26, 2015; Published: May 29, 2015


Recent progress in pediatric IBD studies reveals that genetic factors play an important role in pediatric IBD; mutations associated with VEO-IBD have been identified from IL10 and IL10 receptors; the IL10 gene and genes in IL10 pathway are identified to be associated with pediatric IBD, and epistasis interaction of SNPs/genes in IL10 pathway is shown to contribute to pediatric IBD. IL10 is an anti-inflammatory cytokine and the IL10/STAT3 signaling pathway plays an important role in controlling inflammation and homeostasis. IL10 is a target candidate gene for IBD clinical therapy.

Keywords: Pediatric IBD; Anti-inflammatory cytokine; Inflammation


Inflammatory bowel disease (IBD), consisting of ulcerative colitis (UC) and Crohn’s disease (CD), is a major gastrointestinal chronic inflammatory condition that affects approximately 1.4 million people in America. IBD is a very heterogeneous complex disease. Clinically it presents with a large range of symptoms. Severity differs in gender, race, diet, life style, and other factors [1, 2].

IBD can present at any age, but between 15% and 25% of cases will be diagnosed in childhood [3-5]. The general trend shows that the overall incidence for pediatric IBD is increasing over the past few decades; the incidence for pediatric IBD varies among different countries [6]. From a recent study showed an increase in the incidence of pediatric IBD in Ontario Canada from 9.54 (in 1994) to 11.43 (in 2005) per 100,000 populations [7].

Pediatric IBD

For use in clinical practice and basic scientific research in inflammatory bowel disease, IBD is classified into different groups based on IBD disease phenotype. Age of onset is one of the predominant phenotypic elements. According to age at diagnosis, the IBD was classified into two groups in Vienna classification (1998) [8]: A1, below and A2 above 40 years. The A1 group was further classified into two groups in Montreal classification (2006) [9]: A1 below 16 years and A2 between 17 and 40 years (Table 1). The Montreal A1 group is pediatric IBD [9]. Pediatric IBD presents with symptoms such as frequent diarrhea, stomach cramping, fevers, and weight loss. Some children may present with abdominal pain and depression. Pediatric IBD is more often found as Crohn’s disease (CD) than ulcerative colitis (UC). Symptoms can begin slowly or come on suddenly and progress quickly. Symptoms can also range widely from very mild to sometimes severe. Most importantly, growth retardation is common in pediatric IBD.

In pediatric IBD, less than 1% of patients may also develop IBD in the neonatal or infantile period [10]. These are described as VEO (very early onset) IBD. Clinical characteristics of the VEO-IBD seem to be different from those of adult-onset or adolescent-onset IBD, such as severity and increased resistance to immunosuppressive treatment [11, 12].

As more VEO-IBD (diagnosis at 0-5 years) cases are reported and more genetic mutations/variations associated with VEO-IBD are identified, VEO/pediatric IBD becomes one of the front areas of IBD basic research and clinical investigation. The dynamic features of pediatric disease phenotype such as disease location, behavior, and growth failure were not sufficiently captured in the previous classification. Recently important modifications have been made in the Paris classification [13]. The Montreal A1 group (below 16 years) is further classified into the A1a (0-9 years) and A1b (10-16 years) subgroups [13] (Table 1). Patients who are diagnosed at very early age are often present with a different and more severe disease than older children and adults with IBD. Currently, the VEO-IBD has not been well characterized [14, 15]. Delays in treatment can make IBD worse and lead to severe anemia from gastrointestinal bleeding, poor food absorption, malnutrition and stunted growth. In advanced cases, although few cancers and deaths have been reported [16], IBD can cause serious damage to the colon and small intestine that requires surgery.

Citation:Lin Z. Current Progress in Pediatric Inflammatory Bowel Disease. J Fam Med. 2015;2(3): 1030. ISSN:2380-0658