ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

Levine, Arie*; Koletzko, Sibylle; Turner, Dan; Escher, Johanna C.§; Cucchiara, Salvatore||; de Ridder, Lissy§; Kolho, Kaija-Leena; Veres, Gabor#; Russell, Richard K.**; Paerregaard, Anders††; Buderus, Stephan‡‡; Greer, Mary-Louise C.§§; Dias, Jorge A.||||,¶¶; Veereman-Wauters, Gigi##; Lionetti, Paolo***; Sladek, Malgorzata†††; Martin de Carpi, Javier‡‡‡; Staiano, Annamaria§§§; Ruemmele, Frank M.||||||; Wilson, David C.¶¶¶

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0000000000000239
Society Guideline
Abstract

Background: The diagnosis of pediatric-onset inflammatory bowel disease (PIBD) can be challenging in choosing the most informative diagnostic tests and correctly classifying PIBD into its different subtypes. Recent advances in our understanding of the natural history and phenotype of PIBD, increasing availability of serological and fecal biomarkers, and the emergence of novel endoscopic and imaging technologies taken together have made the previous Porto criteria for the diagnosis of PIBD obsolete.

Methods: We aimed to revise the original Porto criteria using an evidence-based approach and consensus process to yield specific practice recommendations for the diagnosis of PIBD. These revised criteria are based on the Paris classification of PIBD and the original Porto criteria while incorporating novel data, such as for serum and fecal biomarkers. A consensus of at least 80% of participants was achieved for all recommendations and the summary algorithm.

Results: The revised criteria depart from existing criteria by defining 2 categories of ulcerative colitis (UC, typical and atypical); atypical phenotypes of UC should be treated as UC. A novel approach based on multiple criteria for diagnosing IBD-unclassified (IBD-U) is proposed. Specifically, these revised criteria recommend upper gastrointestinal endoscopy and ileocolonscopy for all suspected patients with PIBD, with small bowel imaging (unless typical UC after endoscopy and histology) by magnetic resonance enterography or wireless capsule endoscopy.

Conclusions: These revised Porto criteria for the diagnosis of PIBD have been developed to meet present challenges and developments in PIBD and provide up-to-date guidelines for the definition and diagnosis of the IBD spectrum.

Author Information

*Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany

Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel

§Pediatric Gastroenterology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

||Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy

Children's Hospital, University of Helsinki, Helsinki, Finland

#Semmelweis University, Budapest, Hungary

**Department of Paediatric Gastroenterology and Nutrition, Yorkhill Children's Hospital, Glasgow, UK

††Department of Paediatrics, Hvidovre University Hospital, Copenhagen, Denmark

‡‡St.-Marien-Hospital, Department of Pediatrics, Bonn, Germany

§§Department of Diagnostic Imaging, The Hospital for Sick Children

||||Department of Medical Imaging, University of Toronto, Toronto Canada

¶¶Hospital S. João, Porto, Portugal

##Pediatric Gastroenterology and Nutrition, UZ Brussels, Brussels, Belgium

***Departement Neurofarba, University of Florence, Meyer Children Hospital, Florence, Italy

†††Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland

‡‡‡Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain

§§§Department of Translational Medical Sciences, Section of Pediatrics, University of Naples “Federico II,” Naples, Italy

||||||Université Sorbonne Paris Cité, Université Paris Descartes, INSERM U989, AP-HP, Hôpital Necker Enfants Malades, Service de Gastroentérologie Pédiatrique, Paris, France

¶¶¶Child Life and Health, University of Edinburgh, Edinburgh, UK.

Address correspondence and reprint requests to Professor David C. Wilson, MD, Child Life and Health, University of Edinburgh, 20 Sylvan Place, Edinburgh EH9 1UW, UK (e-mail: d.c.wilson@ed.ac.uk).

Received 30 October, 2013

Accepted 6 November, 2013

Drs Levine, Koletzko, and Wilson contributed equally to the article.

Drs Levine, Koletzko, Turner, Escher, Cucchiara, de Ridder, and Wilson are steering committee members.

A.L. has received consultation fees, speaker's fees, meeting attendance support or honoraria from MSD, Abbott, Ferring, Falk, and Nestle; S.K. has received consultation fees, speaker's fees, meeting attendance support, or research support from MSD, Abbott, Immundiagnostik, Danone, Janssen, and Nestle; D.T. has received consultation fees, speaker's fees, meeting attendance support, research support, or honoraria from MSD, Abbott, Ferring, Nestle, Shire, and Centocor; J.C.E. has received consultation fees, speaker's fees, meeting attendance support, or research support from MSD and Janssen; S.C. has received consultation fees from MSD and Pfizer; L.d.R. has received consultation fees, speaker's fees, meeting attendance support, or research support from MSD, Abbott, and Shire; K.L.K. has received consultation fees, speaker's fees, or meeting attendance support from MSD, Abbott, Biocodex, and Tillotts Pharma; G.V. has declared no conflicts of interest; R.K.R. has received consultation fees, speaker's fees, meeting attendance support, or research support from MSD, Ferring, Dr Falk, and Nestle; A.P. has received consultation fees and/or speaker from MSD, Nestlé, and BioCare; S.B. has received consultation fees, speaker's fees, or meeting attendance support from Falk-Foundation, MSD, Nestle, Norgine, and Pfrimmer; M.C.G. has reported no conflicts of interest; J.A.D. has reported no conflicts of interest; G.V.-W. has received consultation fees from MSD, Abbott, Mead Johnson, and Novalac; P.L. has received consultation fees, speaker's fees, and meeting attendance support form Abbvie, Danone Reearch, Nestlè, MSD, and Ferring; M.S. has received consultation fees, speaker's fees, meeting attendance support from MSD, Abbott, Ferring, Ewopharma, Nutricia, and Nestle; J.M.d.C. has received consultation fees, speaker's fees, meeting attendance support, or research support from MSD, Abbott, Ferring, Nestle, Otsuka, and Fresenius Kabi; A.S. reports the following—Movetis (advisory board), Valeas (speaker Bureau); D.M.G. Italy (consultant); Mead Johnson (Speaker Bureau); F.M.R. reports the following—advisory board member or speaker for MSD, Jansen and Jansen, Nestlé, Mead Johnson, Danone, and Biocodes; D.C.W. has received consultation fees, speaker's fees, meeting attendance support, or research support from MSD, Abbott, Ferring, Shire, Warner Chilcott, Pfizer, and Nestle.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,