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Pediatric Inflammatory Bowel Disease: What Children Can Teach Adults

Over the past 50 years, inflammatory bowel disease (IBD) has become 1 of the major chronic gastrointestinal (GI) diseases among children and adolescents in the westernized world. Approximately 10% of people who suffer from IBD are under the age of 18 years, and 30% are diagnosed before their 21st birthday. Consequently, pediatric gastroenterologists have an intense interest in this disease entity. Pediatric gastroenterologists have largely relied on clinical studies conducted by internists for evidence of drug efficacy in IBD and used those same drugs in the treatment of children. The many reasons for this approach include the relative rarity of IBD in children, the reluctance of the pharmaceutical industry to study drugs in children, the lack of a federal mandate to do so, and the ethical issues involving controlled drug trials in pediatric patients. However, to use the often repeated cliché, children are not small adults: drug efficacy, metabolism, and toxicities are different. In addition, the genetic, immunologic, and environmental components that determine disease phenotype may also be different. Over the past 2 decades, the government, the pharmaceutical industry, and research organizations studying IBD have begun to recognize the importance of studying children and adolescents. Recent federal legislation and new Food and Drug Administration guidelines have encouraged industry to study drug pharmacokinetics and efficacy in young patients with IBD. Important lessons are emerging from knowledge gained by studying children. Here are 7 important lessons that gastroenterologists caring for adults can learn from children and adolescents with IBD (Table 1).