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Health Supervision in the Management of Children and Adolescents With IBD: NASPGHAN Recommendations

Rufo, Paul A.*; Denson, Lee A.; Sylvester, Francisco A.; Szigethy, Eva§; Sathya, Pushpa||; Lu, Ying; Wahbeh, Ghassan T.#; Sena, Laureen M.**; Faubion, William A.††

Journal of Pediatric Gastroenterology and Nutrition: July 2012 - Volume 55 - Issue 1 - p 93–108
doi: 10.1097/MPG.0b013e31825959b8
Consensus Statement

ABSTRACT Ulcerative colitis (UC) and Crohn disease (CD), collectively referred to as inflammatory bowel disease (IBD), are chronic inflammatory disorders that can affect the gastrointestinal tract of children and adults. Like other autoimmune processes, the cause(s) of these disorders remain unknown but likely involves some interplay between genetic vulnerability and environmental factors. Children, in particular with UC or CD, can present to their primary care providers with similar symptoms, including abdominal pain, diarrhea, weight loss, and bloody stool. Although UC and CD are more predominant in adults, epidemiologic studies have demonstrated that a significant percentage of these patients were diagnosed during childhood. The chronic nature of the inflammatory process observed in these children and the waxing and waning nature of their clinical symptoms can be especially disruptive to their physical, social, and academic development. As such, physicians caring for children must consider these diseases when evaluating patients with compatible symptoms. Recent research efforts have made available a variety of more specific and effective pharmacologic agents and improved endoscopic and radiologic assessment tools to assist clinicians in the diagnosis and interval assessment of their patients with IBD; however, as the level of complexity of these interventions has increased, so too has the need for practitioners to become familiar with a wider array of treatments and the risks and benefits of particular diagnostic testing. Nonetheless, in most cases, and especially when frequent visits to subspecialty referral centers are not geographically feasible, primary care providers can be active participants in the management of their pediatric patients with IBD. The goal of this article is to educate and assist pediatricians and adult gastroenterology physicians caring for children with IBD, and in doing so, help to develop more collaborative care plans between primary care and subspecialty providers.

*Center for Inflammatory Bowel Disease, Children's Hospital Boston, Boston, MA

Department of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Connecticut Children's Medical Center, Hartford, CT

§Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA

||Department of Pediatrics, Janeway Child Health Centre, Memorial University of NL, St John's, NL Canada

Division of Pediatric Gastroenterology, Cohen Children's Medical Center of New York, North Shore–Long Island Jewish Health System, New Hyde Park, NY

#Seattle Children's Hospital, University of Washington Seattle, WA

**Department of Radiology, Children's Hospital Boston, Boston, MA

††Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Paul A. Rufo, MD, MMSc, Center for Inflammatory Bowel Disease, Children's Hospital Boston, Boston, MA 02115 (e-mail:

Received 20 March, 2012

Accepted 26 March, 2012

P.A.R. receives research support from TechLab. L.A.D. receives grant funding from NIH and CCFA. E.S. receives grant funding from NIMH/NIH, payment for lectures as a CME speaker for Scripps, and gave a lecture funded by Merck. P.S. attended advisory board meetings for Merck/Janssen, received payment for lectures from Janssen and AstraZeneca, and travel/CME expenses paid by Merck/Janssen. G.T.W. receives payment for lectures from Centocor, and UCB, and his institution receives grant funding from Centocor, UCB, and Abbott. W.A.F. receives consultancy fees from Genentech, Shire, and Centocor, and grant funding from NIH, and the Leona Helmsley Foundation. F.A.S., Y.L., and L.M.S. report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN