Inflammatory bowel disease in paediatrics: Navigating the old challenges and emerging frontiers

Abstract

Pediatric inflammatory bowel disease (IBD), encompassing Crohn’s disease, ulcerative colitis, and IBD-unclassified, has become increasingly prevalent worldwide, including in previously low-incidence regions. Children often present with more extensive and aggressive disease, creating unique diagnostic and management challenges that differ significantly from adult-onset IBD. This review aims to synthesize current knowledge on pediatric IBD, highlighting historical challenges while exploring emerging frontiers in diagnosis, treatment, and long-term care strategies. A narrative synthesis of global and regional epidemiological data, clinical classifications, diagnostic advancements, management approaches, and psychosocial considerations was conducted, with a particular emphasis on innovations in precision medicine, microbiome-targeted therapy, and multidisciplinary care models. Pediatric IBD continues to rise globally, driven by environmental and genetic interactions, especially in rapidly industrializing regions. Novel diagnostic tools, age-specific treatment protocols, biologics, nutritional strategies, and psychosocial support are reshaping care. Emphasis on very early-onset IBD, transition care, and regional policy adaptations underscores the evolving complexity of managing pediatric IBD. The landscape of pediatric IBD care is rapidly evolving. Addressing the distinct pathophysiology, developmental impact, and healthcare challenges of pediatric patients requires an integrated, child-centered approach. Ongoing research into genetics, immune pathways, and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.

Keywords: Pediatric inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Inflammatory bowel disease-unclassified; Very early-onset inflammatory bowel disease; Precision medicine; Nutritional therapy; Biologic therapy; Psychosocial impact; Multidisciplinary care

Core Tip: Pediatric inflammatory bowel disease (IBD) is increasing globally, with rising incidence in previously low-prevalence regions such as the Arabian Gulf. This review highlights the unique challenges in pediatric IBD diagnosis, including atypical presentations and very early-onset IBD, and emphasizes the need for age-specific treatment approaches. It also explores emerging frontiers such as personalized medicine, biologic therapies, and multidisciplinary care. By integrating recent data on epidemiology, pathogenesis, and psychosocial impact, this article presents a comprehensive framework for optimizing outcomes in children with IBD, guiding future research and policy priorities in this evolving field.