Adolescent inflammatory bowel disease: assessment,treatment and transition

Abstract

Paediatric inflammatory bowel disease (IBD) most usually evolves during adolescence, a time of great challenge. For the adolescent, the disease should be thoroughly assessed by upper gastrointestinal endoscopy and ileo-colonoscopy, preferably performed under general anaesthetic or conscious sedation, with relevant radiological examination. This will enable the determination of diagnosis, IBD subtype and extent. Growth also needs to be assessed and the effect of disease on academic and social functioning must be explored. Unlike adult IBD, there is a poor evidence base for the medical and nutritional management of adolescent IBD. However, within the UK it is common practice to use exclusive enteral nutrition rather than corticosteroids for the induction of Crohn’s remission, and to have early recourse to immunomodulation with azathioprine (and methotrexate for azathioprine/6MP intolerance or non-response) unless remission is rapidly induced and maintained. There should be close collaboration with paediatric and colorectal surgeons. Adolescents need higher relative drug doses than the literature suggests for adult IBD patients. Transition clinics are vital for adolescent care and provide a helpful source of second opinion for the paediatric gastroenterologist. Adolescents with IBD are best looked after by the paediatric gastroenterology multidisciplinary team (or in shared care with that team). In this overview we highlight these key areas of assessment, treatment and transition.