Inflammatory Bowel diseases (IBD), which include Crohn’s disease and ulcerative colitis, are chronic inflammatory diseases that affect the gastrointestinal tract. Crohn’s disease can affect anywhere from the mouth to the anus, while ulcerative colitis only affects the colon (the large intestine). IBD is a disease that primarily affects young adults; however, up to 25% of all individuals with IBD will be diagnosed by age 18. There is also a special group of inflammatory bowel diseases known as very early onset IBD (VEOIBD), which include children who are 5 years or younger at the time they are diagnosed.
IBD can be caused by a number of factors. While specific causes and cures are not yet known, ongoing research shows it is a combination of genetics, environmental triggers, and changes in the bacterial composition of the GI tract that leads to an inflammatory response.
Living with Crohn’s disease can be challenging because patients will frequently have abdominal pain, nausea, diarrhea, malaise, joint pain, and blood in their stools. Advancement in treatments has made it easier to limit complications, improve quality of life, reduce surgery risk, and allow for long periods of remission.
While there are no cures yet for IBD, there are different treatment regimens that help a patient achieve the main goals of therapy: decrease the initial inflammation (“induction” therapy), sustained remission of inflammation with healing of the lining of the GI tract - mucosa (“maintenance” therapy), minimize exposure to steroids, and prevention of worsening disease and complications from IBD itself.
These therapies can help minimize symptoms, improve and maintain good growth, and improve the quality of life. The patient’s healthcare team makes treatment decisions based on many factors, including the severity and location of their inflammatory bowel disease, nutritional and growth status, and previous responses to other medications.
The newest class of medications are known as “biologics.” The first drug infliximab (Remicade) was FDA approved almost 20 years ago and is currently approved for pediatric and adult Crohn’s disease. Since then, other biologics similar to infliximab have been approved, including adalimumab (Humira) and certolizumab pegol (Cimzia). Adalimumab is also FDA approved for pediatric and adult patients with Crohn’s disease, while certolizumab pegol is only approved to treat adult patients.
In patients with IBD, inflammatory chemicals that are normally produced to fight infections are often overproduced which can lead to inflammation in the intestines. These medications act against those chemicals to help reduce inflammation. Pharmaceutical companies have started to develop very similar versions of biologics known as biosimilars. Recently the FDA has approved the use of biosimilars to infliximab and adalimumab. The hope is that biosimilars will be as effective as its counterparts. Recently there are two new classes of biologic agents that have been approved to treat Crohn’s disease in adult patients with different ways to target inflammation.
Besides medications that are currently available, there is a lot of interest in using and studying different diets in the treatment of Crohn’s disease. We are currently using nutritional therapy to induce remission and maintain remission with great success.
The future continues to be very bright in the treatment for patients with IBD. As a pediatric gastroenterologist who specialized in the care of children with inflammatory bowel diseases, I am optimistic that we will move towards individualized precision medicine to select the best treatment for our patients, which will lead to more effective healing of the intestinal mucosa, decreased need for surgery, and most importantly, better quality of life for ALL children and young adults who live with IBD on a daily basis.