In this podcast, Dr Marc Rhoads discusses highlights from his recent presentation at the Advances in Inflammatory Bowel Disease 2021 Regional conference.

Marc Rhoads, MD, is the the section head of pediatric gastroenterology at the University of Texas McGovern Medical School in Houston.

TRANSCRIPT:

Angelique Platas: Welcome to another podcast from the Gastroenterology Learning Network. In this episode, Dr. Marc Rhoads will be discussing his recent presentation at the AIBD Conference.

Dr. Marc Rhoads: Hello. My name is Marc Rhoads and I'm happy to be with you today. I'm the section head of pediatric gastroenterology at the University of Texas McGovern Medical School in Houston. I'd like to tell you the major points of my presentation for AIBD, comparing children with adults.

First of all, children are more likely to present with extraintestinal manifestations. In fact, about a third of children present with manifestations outside of the gastrointestinal tract. These include growth failure, arthritis, and stomatitis. 

The other observation about children who present with IBD is that they usually present with ileocolonic disease—the vast majority of them, 75 to 80%—whereas in adults older than the age of 60, there's a predominance of colonic disease. We rarely see that in children. In addition, we often see gastroduodenal inflammation in children with ulcerative colitis. That's more common in children than in adults. That's point number one.

The second point is that children are very good responders to medications when you look at their response to biologic medicines for Crohn's disease. For example, compared with the adult Crohn's disease literature, the multi-center trials and systematic reviews, we find that children respond about 10 to 15% better, so that we can achieve a 40 to 50% steroid-free remission rate with most of the biologics that we use. 

We do monitor drug levels and antibody levels prospectively in our institution.

The third point is that growth failure used to be quite predominant in children that were diagnosed with inflammatory bowel disease, quite prevalent. We're not finding this anymore. Most of the children will present with a Z score for height and a Z score for weight that's about one standard deviation below the norm, and then they'll catch up.

To actually see a child that's stunted with a score of minus two Z scores for height, that's unusual. You're looking at less than 10% of children that present that way. By the time they reach adulthood, most of them have caught up. The only ones that end up one or two centimeters shorter than their peers are those that are diagnosed at an age less than 14.

Then, the final point is that we're going to learn more and more about the pathogenesis of inflammatory bowel disease by studying the genetic makeup and the microbiome in children that have inflammatory bowel disease. There's a lot to learn. Right now, both of these factors contribute to less than 15% of the etiology of IBD, we believe. 

We'll be learning more. We're going to learn the most, most likely, from children that are less than the age of six. We call this population very early onset IBD. 

We've already identified a whole host of genes that can cause it. Some of these are known to cause immunodeficiency syndromes, such as Wiskott-Aldrich syndrome, chronic granulomatous disease, X-linked lymphoproliferative syndrome, or common variable immunodeficiency. 

Most of the children, even when they have mutations in these genes, present just as inflammatory bowel disease. The treatments for some of these involve bone marrow transplant, rather than standard IBD therapy.

Then, the microbes are very important. Of course, by the age of six, you probably have your full cohort of microbes that you're going to have the rest of your life. Microbial manipulation may occur more successfully the younger the child is.

Those are the main points that I hope I made in my talk. Again, it's been a pleasure to be with you.