Eric Benchimol, MD, on Pediatric IBD: The Year in Review

Dr Benchimol reviews important studies and publications from 2023 that concern the care of children with inflammatory bowel disease, which he spoke on at the 2023 AIBD Annual Meeting.

Eric Benchimol, MD, is a professor of pediatrics and clinical research at the University of Toronto and a pediatric gastroenterologist at the Hospital for Sick Children in Toronto, Ontario, Canada.

TRANSCRIPT:

My name is Eric Benchimol. I'm a pediatric gastroenterologist at the Hospital for Sick Children in Toronto, and a professor of pediatrics and clinical epidemiology at University of Toronto. I study the health system and how it treats people with inflammatory bowel disease, particularly children, but also try to understand the causes of inflammatory bowel disease and why rates are rising so rapidly in children around the world. I presented on the year in review in pediatric IBD, looking at all the most important papers and papers published over the past 12 months that really made an impact on both the treatment and our understanding of the disease, as well as how we can improve treatment for people with IBD for children and their families living with IBD. Some of the themes that I presented on in the year in review was some epidemiology studies, trying to understand the causes of the rising rates of pediatric IBD.

There were a couple of studies looking at fitness, physical fitness, cardiovascular endurance, with its association with later onset of pediatric IBD as well as even screen time. So trying to understand perhaps that there's a link between physical activity and fitness and the microbiome potentially in order to follow patients and prevent IBD one day in the future, we can intervene in some of these environmental risk factors. The second theme that I spoke about was the treatment of children with IBD and unfortunately we don't have access to FDA-approved medications, with the exception of infliximab and adalimumab. Our treatment choices are very limited. And so some of the papers that I focused on really looked at how to use these medications better, the ones that we have available, whether it's through use of combination therapy, whether it's through use of proactive therapeutic drug monitoring, and also there was a very nice paper published this year from Europe looking at drug development and access to drugs to children with IBD, really trying to facilitate the process so we're no longer in the situation of an 8-year delay between the approval for adult utilization in IBD and the approval for pediatric utilization.

So those were really important papers. We reviewed things like the combined study, which was a clinical trial looking at concomitant immunomodulators, showing some benefit with adalimumab. We also reviewed other clinical trials, other outcomes studies as well, looking at whether these treatments are making a difference in children with IBD. One study from France, the Epimed cohort, found a nice reduction in the rate of colectomy in ulcerative colitis patients. And a study from Canada that I was part of, the Canadian children IBD network, found predictors of requiring infliximab in acute severe ulcerative colitis being low albumin, pka or pediatric ulcerative colitis index, which had not changed over time, as age, older age, and male gender predicting your increased likelihood of requiring infliximab for pediatric ulcerative colitis, acute severe ulcerative colitis.

And then the last theme that I spoke extensively about was mental health in children with IBD. That has become increasingly important, especially after the pandemic. We're recognizing really an epidemic of anxiety and multiple studies produced this year showed increased risk of anxiety and depression in children living with IBD and in fact, rates of mental illness were highest amongst IBD patients, children with IBD, even compared to other immune mediated inflammatory diseases. Although JIA patients and connective tissue disorder patients also had high rates of psychiatric diagnoses, we looked at some of the treatments with cognitive behavioral therapy being shown effective in adults with IBD as well as different models of caring for the mental health of children with IBD.

And I think that was a really interesting discussion because it followed really well on a talk that was after mine by Carlo de Lorenzo, who reviewed IBS and IBD overlap and the brain gut axis, and also reviewed the importance of addressing mental health screening for it and treating it if you find it, in order to reduce that risk of IBS, but potentially also reduce the failing medications for IBD. One of the final topics we talked about this morning actually in the editor's focus was on precision medicine and an approach to precision medicine in monogenic forms of IBD. So that was previously called very early onset IBD, but we're really talking about the people, mostly children, but some adults as well who have a single gene mutation that results in the development of IBD or an IBD like illness.

And there was an excellent paper published in Nature Reviews looking at our approach to both diagnosing monogenic IBD, but then also studying the causes of monogenic IBD and how we can treat people better with monogenic IBD. And I think the group of researchers and physicians who are studying monogenic IBD really is the first stage to precision medicine approaches to overall IBD. I think we're going to see our most rapid forward progression with precision medicine approaches in monogenic IBD, but we'll begin to see it in all ages and all phenotypes as well going forward in the next 10 years. So I thought that that IBD reports paper was an excellent structure for how to approach precision medicine in IBD overall.