IBD Diagnoses Rising in Children

Marcia Frellick

January 21, 2020

AUSTIN, Texas — The average age of inflammatory bowel disease (IBD) diagnosis is getting lower, according to Ashish Patel, MD, director of the Southwestern Center for Pediatric IBD at Children's Medical Center Dallas. "Approximately a quarter of patients newly diagnosed with IBD are diagnosed under the age of 20," he reported, adding that the youngest patient he has seen is younger than 12 months.

And the number of children with IBD is increasing. "We used to see one or two new diagnoses a month. Now we're averaging about two to four," he told Medscape Medical News.

The upcoming Crohn's and Colitis Congress 2020 will highlight efforts to optimize increasingly targeted therapies for children with IBD that are helping to push surgery further down the line of options.

"Historically, we may have said you need to consider surgery, even at a young age," said Patel, but advances in anti-TNF drugs mean that now, if a patient doesn't respond to the first drug, there are other options. Another drug might be able to block a different pathway of inflammation — using the interleukin (IL)-23 or IL-12 pathways — for instance.

The conference brings together experts on Crohn's disease and colitis in both adult and pediatric populations.

Traditionally, adolescents have been the focus of pediatric IBD research, but studies in younger children, who are relatively naïve to the environment, will be essential to help us better understand genetic contributions to the disease and get closer to a cure, Patel said.

"I think at least certain types of this disease will have a cure in the lifetime of the kids I take care of right now," he added.

Speakers at the Congress will also share beyond-the-gut manifestations of the disease. "We see kids with debilitating joint disease or skin rashes, inflammation in their eyes or ulcers in their mouths. These can all be related to underlying IBD," he explained.

And weight loss and lack of growth can be a little-known marker for IBD, he said.

The latest advice on diets, some that target symptoms and others that target inflammation, will be presented during the pediatric sessions.

Results from an analysis of the risk for lymphoma in more than 9000 children with IBD treated over a decade with anti-TNF agents will also be presented.

Although anti-TNF agents are among the most effective treatments available, physicians sometimes avoid prescribing them because of a concern that they are associated with lymphoma.

Heightened Risk for Infection

The increased risk for certain infections in kids with IBD and the importance of keeping vaccines on the gastrointestinal radar will be addressed by Ravi Jhaveri, MD, associate division head and infectious disease professor of pediatrics at the Northwestern University Feinberg School of Medicine in Chicago.

Immune therapy has advanced, and options for IBD have expanded from steroids to anti-TNF agents, but there have been unintended consequences in the form of increased risk for certain kinds of infections, he told Medscape Medical News.

Among those are skin and skin-structures-associated infections. Many IBD patients tend to have perianal skin breakdown and perianal abscesses, he explained, but the abscesses can show up anywhere.

"That's a burden we don't always think about and recognize," Jhaveri pointed out.

"There's a learning curve in sharing experience in the infections we encounter and in how we protect these patients, whether it's with vaccines or antibiotic suppression or other interventions," he said.

Because children with IBD often see several practitioners, the monitoring of adherence to the vaccine schedule can be inconsistent, he said.

There is still reluctance on the part of some primary care physicians to treat children on suppressive regimens.

"We do our best to make it clear that a lot of these vaccines have very little risk and a lot of upside for patients on suppressants, especially when you are not talking about live vaccines," he said. "The only real risk is that they won't respond as well."

Crohn's and Colitis Congress (CCC) 2020.

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