Paediatric inflammatory bowel disease: an update on current practice

Paediatric inflammatory bowel disease (PIBD), consisting of Crohn's disease, ulcerative colitis and inflammatory bowel disease unclassified, is a spectrum of chronic inflammatory conditions associated with significant morbidity. The incidence of PIBD continues to increase and disease phenotype is more severe than adult-onset disease. Referral to specialist services and diagnosis of PIBD can be slow; and faecal calprotectin is an invaluable tool for the prioritization of further investigation. Greater understanding of pre-existing treatments (such as anti-TNF monoclonal antibody therapy) and a growing arsenal of biologic and small molecule drugs have brought about significant changes in disease management. Whilst important challenges remain in the longer-term treatment of PIBD, including growth, nutrition and management of refractory disease, there remains a strong research focus on understanding underlying disease pathogenesis and a move towards personalized medicine. This review describes investigations, diagnosis and management of PIBD and presents contemporary evidence on nutritional and medical management.