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World J Gastroenterol. May 28, 2017; 23(20): 3624-3631
Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3624
Transition of pediatric to adult care in inflammatory bowel disease: Is it as easy as 1, 2, 3?
Anita Afzali, Ghassan Wahbeh
Anita Afzali, Division of Gastroenterology, University of Washington, Harborview Medical Center, Seattle, Washington, WA 98104, United States
Ghassan Wahbeh, Division of Gastroenterology, Seattle Children’s Hospital, University of Washington, Seattle, Washington, WA 98105, United States
Author contributions: Afzali A performed the research and wrote the paper; Wahbeh G contributed critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: The authors declare that there are no conflicts of interests regarding the publication of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anita Afzali, MD, MPH, Division of Gastroenterology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359773, Seattle, Washington, WA 98104, United States. anitaa@medicine.washington.edu
Telephone: +1-206-7447055 Fax: +1-206-7448698
Received: January 24, 2017
Peer-review started: February 1, 2017
First decision: March 19, 2017
Revised: April 8, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: May 28, 2017
Processing time: 122 Days and 15 Hours
Abstract

Inflammatory bowel disease (IBD) is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population, and up to 25% of IBD patients are diagnosed before 18 years of age. Adolescents with IBD tend to have more severe and extensive disease and eventually require graduation from pediatric care toadult services. The transition of patients from pediatric to adult gastroenterologists requires careful preparation and coordination, with involvement of all key players to ensure proper collaboration of care and avoid interruption in care. This can be challenging and associated with gaps in delivery of care. The pediatric and adult health paradigms have inherent differences between health care models, as well as health care priorities in IBD. The readiness of the young adult also influences this transition of care, with often times other overlaps in life events, such as school, financial independence and moving away from home. These patients are therefore at higher risk for poorer clinical disease outcomes. The aim of this paper is to review concepts pertinent to transition of care of young adults with IBD to adult care, and provides resources appropriate for an IBD pediatric to adult transition of care model.

Keywords: Inflammatory bowel disease; Adolescents; Young adults; Transition care; Transition to adult care

Core tip: The process of transition of a young adult with inflammatory bowel disease (IBD) to adult care should be well coordinated and incorporate all key players to ensure proper collaboration and avoid interruption in care. An early, regular assessment of the adolescent readiness for transition is important. The adolescent patient should be seen without the parent or caregivers in order to build self-reliance. Pediatric gastroenterologists need to discuss and introduce the concept of transition with the patient and family early and identify adult gastroenterologists with unique interests in young adults with IBD. The adult gastroenterologist should be prepared for the transition with advanced communication with the referring pediatric team, consider further training in adolescent health, and review health priorities and targets of care early with the young adult.