Letter From the Editor: Using Biologics to Treat Children Who Have Inflammatory Bowel Disease

Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Much of the literature on the treatment of inflammatory bowel disease (IBD) has focused on adult patients, but what about children? This issue of Gastroenterology & Hepatology includes a comprehensive review article on the biologic treatment of pediatric patients who have ulcerative colitis and Crohn’s disease. As Dr Jessica Breton, Dr Arthur Kastl, Dr Maire A. Conrad, and Dr Robert N. Baldassano point out, pediatric IBD is rising in incidence and prevalence around the world, particularly in children younger than 5 years of age, and it appears to have a more severe and aggressive phenotype than adult IBD. The authors review the current pediatric IBD literature for the efficacy, clinical pharmacology, and safety of anti–tumor necrosis factor α agents, as well as the off-label use of newer agents such as vedolizumab and ustekinumab. The authors also examine the difficulties of conducting clinical drug trials in pediatric patients who have IBD.

Our Advances in GERD column centers on the occurrence of reflux subsequent to the performance of peroral endoscopic myotomy (POEM). Dr Mouen A. Khashab discusses the frequency with which reflux occurs after POEM, how the condition can be diagnosed, whether it can be predicted, whether reflux–related adverse events can be prevented, and how patients should be managed and followed in this setting, along with related issues.

The diagnosis of pancreatic cysts using endoscopy is explored in our Advances in Endoscopy column. Dr Somashekar G. Krishna provides some background information on the classification of pancreatic cysts and describes the endoscopic methods currently being used for diagnosis; how these methods compare to newer modalities; the safety, feasibility, and accuracy of the novel methods; and how to decide which method should be used, among other issues. 

Our Advances in Hepatology column features the hepatic complications that may occur in patients who have congenital cardiac disease. Among other issues, Dr Kalyan Ram Bhamidimarri discusses the various effects that congenital cardiac disease may have on the liver, when a patient should undergo liver transplant and whether it should be performed alone or along with a heart transplant, and the advantages of combined heart and liver transplant.

Finally, the EVOLVE study is the focus of our Advances in IBD column. Dr Brian Bressler discusses the importance and limitations of this study, key study findings that have been presented recently, their clinical implications and importance to the medical community, and how these data impact the positioning of vedoliz-umab, along with related issues.

May this issue provide you with helpful information that you can put to good use in your clinical practice.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc