Pediatric Inflammatory Bowel Disease (IBD)

Crohn's disease (CD) is a chronic inflammatory bowel disease and is the most common form of inflammatory bowel disease (IBD) in children. The Paris Classification of inflammatory bowel disease classifies Pediatric Inflammatory Bowel Disease (IBD) by considering the age at diagnosis, disease location, behavior, and whether there is a growth delay (1, 2). Consequently, Pediatric Inflammatory Bowel Disease (IBD) treatment is tailored based on disease severity and its primary goal is to achieve clinical and histological remission, while minimizing medication side effects (9).

Regarding Pediatric Inflammatory Bowel Disease (IBD), global rates are rapidly increasing, especially for Crohn's disease (CD). 25% of all Inflammatory Bowel Disease (IBD) patients are under 18 years old, and about a quarter of them are under 10 years old. Latest studies show a rapid increase in very early-onset IBD, defined as diagnosis before the age of 6 years (3, 4).

Patients with Pediatric Inflammatory Bowel Disease (IBD) present unique challenges, as they often show more severe intestinal involvement and faster progression. Growth, delayed puberty, nutrient deficiencies, treatment side effects, infections, extraintestinal manifestations, and not least psychosocial support must be well monitored, as 25–40% of adolescent IBD patients show signs of clinical depression, which affects school attendance, medication adherence, and overall quality of life (QoL) (5, 6). Growth failure, weight loss, and specific nutritional deficiencies are common, especially in patients with severe disease (7).

The study of Jang et al. 2025 looked at pieces of small intestine from children with Crohn’s disease and from controls, and mapped exactly which bacteria sit next to which human cells and how those cells react. It showed that Crohn’s tissue, especially inflamed areas, contains more invading bacteria, and that a higher bacterial load at diagnosis is linked to worse endoscopic scores and earlier relapse, so it might help predict prognosis. The authors also distinguished bacterial species that seem to harm the gut from those that seem protective, and found that “good” bacteria are associated with gene programs for tissue repair and survival, while “bad” bacteria are linked to more cell damage and inflammatory responses (10).

Exclusive enteral nutrition (EEN) is a proven first-line induction treatment for active luminal Crohn’s disease (8).

References:

(1) Levine et al. 2011 Inflamm. Bowel Dis. 17: 1314-1321
(2) Day et al. 2012 World J Gastroenterol. 18(41): 5862-5869
(3) Benchimol et al. 2011 Inflamm Bowel Dis 17: 423-439
(4) Kuenzig et al. 2022 Gastroenterology 162: 1147-1159
(5) Clark et al. 2014 J Pediatr Gastroenterol Nutr 58: 569-573
(6) Däbritz et al. 2017 Dtsch Arztebl Int 114: 331-338
(7) Gerasimidis et al. 2011 J Hum Nutr Diet. 24(4): 313-326
(8) Rheenen et al. 2021 Journal of Crohn's and Colitis 2021: 171-194
(9) Goldiș et al. 2025 Life 15: 902
(10) Jang et al. 2025 Microbiome 13: 189

see also:
Breastfeeding & Inflammatory Bowel Disease (IBD)
Butyrate / Butyric acid & Inflammatory bowel disease (IBD)
Colitis / Intestinal Inflammation & Short-Chain Fatty Acids (SCFAs)
Crohn's disease (CD)
Exclusive Enteral Nutrition (EEN) & Crohn’s Disease (CD)
The Montreal classification
NCT05456763 - Sodium butyrate & Inflammatory bowel disease (IBD)
PediFETCh - Fecal Microbiota Transplantation (FMT) & Ulcerative Colitis (UC)
XXX - Sodium butyrate + SoC & Inflammatory bowel disease (IBD)