Joel Rosh, MD, Discusses Treatment Goals for Pediatric IBD

Restoring normal growth, development and psychosocial wellness are the ultimate treatment goals in the treatment of pediatric inflammatory bowel diseases (IBD), according to Joel Rosh, MD, during his presentation at the Advances in Inflammatory Bowel Disease annual meeting in Orlando, Florida, on December 5.

Dr Rosh is director of the pediatric gastroenterology department and vice chairman of the clinical development and research affairs at the Goryeb Children’s Hospital in Morristown, New Jersey. He is also a professor of pediatrics at the Icahn School of Medicine at Mount Sinai in New York.

“Ongoing disease monitoring assures the best likelihood of inducing and then maintaining a durable, deep remission is the key,” said Dr Rosh, a prominent pediatric gastroenterologist whose expertise is in treating chronic stomach pain, ulcers, diarrhea, reflux, cancer and Crohn disease (CD). Ensuring linear growth and skeletal health, steady pubertal development, sticking to a strict vaccination regimen, monitoring psychosocial impact of the disease and periodical surveillance of disease activities form a good road map for clinicians and patients in achieving the target treatment, he stated.

Referring to the abstract from his 2017 study review with Maire Conrad on pediatric IBD, Dr Rosh said that IBD manifests in a variety of symptoms, but esophagogastroduodenoscopy and colonoscopy are imperative to confirming the diagnosis. Treatment goals include achieving mucosal healing of the gastrointestinal tract, reaching growth potential, limiting medication toxicities, and optimizing quality of life for all patients, he said.

CD can be particularly dangerous as it results in slowed growth velocity, delayed puberty, perianal diseases, arthritis and unexplained bouts of fever and anemia.

Treatment goals include inducing remission and then maintaining remission and improving overall quality of life. Just as among adults, clinicians are striving to promote physical and psychological well-being while preventing disease complications among the younger population. “In the end, we all want to avoid surgeries,” Dr Rosh stated.

A systematic literature search using MEDLINE, EMBASE, and Cochrane Central databases revealed the need to identify patients at high risk of a complicated disease course at the earliest opportunity to reduce bowel damage.

For example, patients with perianal disease, structuring or penetrating behavior should be considered for anti-TNF agents combined with an immunomodulator, whereas patients with low-risk luminal CD should be considered for exclusive enteral nutrition or corticosteroids.

When deciding on the avoidance of live vaccinations, Dr Rosh spoke about defining the immunocompromised status of the patients. Treatment with glucocorticoids is recommended “only if more than or equal to 20 mg/d prednisone equivalent or 2 mg/kg/d if less than 10 kg, for 2 weeks or more, and within 3 months of stopping.” Some of the live vaccines recommended for the younger population included rotavirus, measles-mumps-rubella, varicella, zoster, typhoid and yellow fever; and among the inactivated vaccines were tetanus-diphtheria-acellular pertussis, hepatitis A and B, influenza, pneumococcal and meningococcal.

Characterized by dysregulated immune-microbiome interactions in a genetically susceptible host, IBD in children poses a very serious challenge to health care professionals everywhere. “Treatment goals in pediatric IBD must incorporate restoration of normal growth, development, and psychosocial wellness,” Dr Rosh concluded. “Ongoing disease monitoring assures the best likelihood of inducing and then maintaining a durable, deep remission.”

—Priyam Vora

Reference:
Rosh J. Treating patients with IBD who are younger than 21 years old. Presented at: Advances in Inflammatory Bowel Disease Annual Meeting. December 5, 2022. Orlando, Florida.