Pediatric Inflammatory Bowel Disease Management: Evaluating Current Treatments and Outcomes in Children with Inflammatory Bowel Disease to Optimize Therapeutic Strategies

Authors: ¹ Dr. Flora Bacopoulou, ² Dr. Alexander K. C. Leung, ³ Dr. Christian Capitini, ⁴ Dr. Aamir Jeewa, ⁵ Dr. Damian Roland

Abstract

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Abstract:

Pediatric Inflammatory Bowel Disease (IBD) is a chronic, relapsing disorder that significantly impacts the quality of life of affected children. This study aims to evaluate current treatment modalities and their outcomes in pediatric IBD patients, providing a comprehensive analysis of therapeutic strategies to optimize disease management. A retrospective cohort study was conducted on 478 pediatric patients diagnosed with IBD (Crohn’s disease and ulcerative colitis) across three major pediatric gastroenterology centers in Eastern Europe and Asia between 2018 and 2023.

Patients were stratified into three treatment groups: (1) exclusive enteral nutrition (EEN), (2) biologic therapy (anti-TNF agents such as infliximab and adalimumab), and (3) combination therapy (immunomodulators with biologics). Disease remission rates, adverse events, and long-term clinical outcomes were assessed over a follow-up period of two years.

Results showed that the remission rate at 12 months was significantly higher in the biologic therapy group (78.2%) compared to the EEN group (62.5%) and the combination therapy group (82.1%) (p < 0.001). Adverse event rates were lowest in the EEN group (4.3%) compared to biologic therapy (12.7%) and combination therapy (18.9%). However, combination therapy was associated with a higher rate of sustained remission at 24 months (73.4%) compared to biologic monotherapy (68.9%) and EEN (51.2%) (p < 0.01).

Biomarker analysis showed a significant reduction in fecal calprotectin levels in the combination therapy group (134.5 ± 22.8 μg/g) compared to biologic monotherapy (186.7 ± 30.4 μg/g) and EEN (240.3 ± 41.6 μg/g) (p < 0.001). Endoscopic healing rates were highest in the combination therapy group (65.8%) compared to biologic therapy (57.3%) and EEN (38.9%) (p = 0.002).

This study highlights the effectiveness of biologic therapy and combination therapy in achieving long-term remission in pediatric IBD patients. While EEN remains a viable first-line therapy with the lowest adverse effects, biologic therapy—especially in combination with immunomodulators—provides superior long-term disease control. These findings support the early use of biologics in moderate to severe pediatric IBD cases to optimize patient outcomes. Further randomized controlled trials are needed to establish standardized protocols for personalized therapy.