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World J Gastroenterol. Aug 14, 2017; 23(30): 5469-5485
Published online Aug 14, 2017. doi: 10.3748/wjg.v23.i30.5469
Treating children with inflammatory bowel disease: Current and new perspectives
Graziella Guariso, Marco Gasparetto
Graziella Guariso, University of Padova, 35100 Padova, Italy
Marco Gasparetto, Department of Paediatric Gastroenterology, Cambridge University Hospitals CUH-FT, Cambridge CB2 0QQ, United Kingdom
Author contributions: Guariso G and Gasparetto M contributed equally to this work in respect to designing the review, contributing to the manuscript with intellectual content, writing the paper and final approval of the version to be published.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
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: Graziella Guariso, Professor, Paediatric Gastroenterologist, University Lecturer, University of Padova, Via 8 Febbraio 1848, 2, 35100 Padova, Italy. graziella.guariso@gmail.com
Telephone: +39-49-8625753 Fax: +39-49-8625753
Received: February 26, 2017
Peer-review started: February 28, 2017
First decision: April 7, 2017
Revised: June 2, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: August 14, 2017
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.

Keywords: Paediatric inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Treatment, Therapy, Immunosuppressant, Biologic, Monitoring, Biomarker

Core tip: This narrative review summarises the current practice in treating children with inflammatory bowel disease (IBD) and explores the new advances and future aims. A particular focus of the review are the peculiarities of the paediatric age in respect to the standard practice in adult patients with IBD. Whilst the cause of this condition remains only partly understood, a significant proportion of children does not respond to the treatment options currently available. Developing new treatments is therefore a key target. Major advances have already been achieved in therapeutic drug monitoring.