OBJECTIVE:To provide an updated, evidence-based European Crohn's and Colitis Organisation [ECCO]-European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] guideline for the management, monitoring, and long-term care of pediatric Crohn's disease [CD]. METHODS:A multidisciplinary panel of 27 experts followed ECCO Standard Operating Procedures for guideline development. A systematic review of studies published between January 2018 and October 2024, with targeted updates through June 2025, was conducted across MEDLINE, EMBASE, and Cochrane Central. Evidence was graded using the Oxford Centre for Evidence-Based Medicine levels. Draft statements underwent two Delphi voting rounds involving the guideline panel, ECCO National Representatives, and an international sounding board; statements achieving ≥80% agreement were accepted. RESULTS:This guideline provides updated recommendations across major domains of pediatric CD care, including risk stratification, treatment targets, induction and maintenance strategies, nutritional therapies, therapeutic drug monitoring, and the roles of imaging and endoscopy. High-risk patients should start anti-TNF therapy as first-line treatment, with proactive and reactive therapeutic drug monitoring to enhance efficacy. For low-risk luminal disease, exclusive enteral nutrition or the Crohn's Disease Exclusion Diet with partial enteral nutrition are preferred induction options. Long-term management emphasizes achieving endoscopic remission, normal growth, improved quality of life, and reduction of bowel damage. This guideline also reviews emerging advanced therapies, including biologics and small molecules, which are increasingly used in practice but generally not yet approved for pediatric CD, to inform clinicians about their potential role. CONCLUSIONS:This updated ECCO-ESPGHAN guideline integrates new pediatric evidence with contemporary adult data and treat-to-target principles, providing practical recommendations to support personalized, multidisciplinary, and proactive management aimed at improving long-term outcomes in pediatric CD.

INTRODUCTION:Disorders of gut-brain interaction (DGBI) are frequently reported in patients with inflammatory bowel disease (IBD), but pediatric data are scarce. We aimed to determine the prevalence of DGBI-like symptoms in children with quiescent IBD compared with healthy controls (HC), and to evaluate their impact on health-related quality of life, anxiety and symptoms burden. METHODS:This multicenter, prospective, observational study enrolled children aged 10-18 years with biochemically quiescent IBD, with or without endoscopic confirmation of remission from 7 European Society of Pediatric Gastroenterology, Hepatology and Nutrition centers (January 2021-August 2023). Age and sex-matched HC were recruited through primary care pediatricians and screened for subclinical inflammation using fecal calprotectin. DGBI were assessed using Rome IV criteria. Health-related quality of life and psychological burden were evaluated using IMPACT III, PROMIS Anxiety, Visceral Sensitivity Index-Child, and Behavioral Response Questionnaire-Child. RESULTS:A total of 253 children were enrolled (IBD: n = 131; HC: n = 122). The prevalence of DGBI-like symptoms did not differ between IBD and HC (34.4% vs 41.8%, P = 0.30). Functional abdominal pain disorders were present in 24.4% of children with IBD. Children with IBD and DGBI-like symptoms showed significantly lower IMPACT III scores compared with those without DGBI [median 74 (interquartile range 62.5-81) vs 84 (70-90); P = 0.001], with the greatest impairment in IBD symptoms, energy, and social domains. PROMIS Anxiety scores were higher in the DGBI group [31 (20-44) vs 21.5 (16-28); P < 0.001], with a greater proportion exceeding the clinical threshold (>50) (17.8% vs 3.5%; P = 0.008). Female sex was the only independent predictor of DGBI (OR 5.2, 95% CI 1.6-16.1; P = 0.005). DISCUSSION:DGBI-like symptoms are common in children with quiescent IBD and are associated with a substantial psychological and quality-of-life burden.

Background and study aims Pan-enteric capsule endoscopy (CE) provides a comprehensive mucosal assessment of both the small bowel and colon in Crohn's disease (CD). However, its incremental impact on structured clinical decision-making and inter-observer agreement remains insufficiently defined. We aimed to evaluate whether the availability of CE findings influences therapeutic decisions, risk stratification and monitoring strategies in patients with CD. Patients and methods We performed a multicentre, retrospective, paired case-based study including 50 real-world CD cases (35 adults, 15 paediatric). For each case, two anonymised vignettes were generated: one incorporating clinical, biochemical and cross-sectional imaging data without CE, and one additionally including CE findings. Ten experienced inflammatory bowel disease (IBD) gastroenterologists (six adult, four paediatric) independently reviewed all vignettes in randomised order using a structured questionnaire. The primary outcome was change in therapeutic decision-making after disclosure of CE findings. Secondary outcomes included changes in risk stratification, assessment of treatment efficacy, timing of follow-up, confidence in decision-making and inter-observer agreement. Results Access to CE findings significantly modified risk assessment and treatment selection. Overall, 53.3% of risk-stratification responses and 56.7% of treatment decisions changed, with a consistent shift towards higher perceived risk and treatment escalation (p < 0.0001 for both). CE also altered monitoring strategies, increasing reliance on endoscopic/CE-based assessment (change rate 36.7%; p < 0.0001), and modestly shortened planned follow-up intervals (change rate 18.5%; p = 0.0366). Confidence scores showed no significant overall shift (p = 0.2700), despite 41.6% of individual ratings changing. Inter-observer agreement improved from fair to moderate across several domains when CE results were available. No cases with isolated colonic CD were included in the final case set, and no capsule retention occurred in the included cohort. Conclusions In this multicentre paired case-based study, pan-enteric CE substantially influenced risk stratification, treatment selection and monitoring plans in CD, while improving inter-observer agreement across several decision domains. These findings indicate that CE meaningfully affects structured clinical decision-making in selected patients, particularly when small-bowel involvement is suspected or when conventional investigations are discordant. Prospective longitudinal studies are needed to determine whether CE-guided decisions translate into improved clinical outcomes.

Gastrointestinal bleeding (GIB) in children can lead to significant morbidity and mortality. GIB is a medical emergency that should not lead to mortality or significant morbidity if the correct and prompt actions are taken. GIB remains the last paediatric emergency from which children may die unnecessarily with a major contribution from the lack of expertise of some medical teams. Novel haemostatic endoscopic techniques are evolving such as adherent clotting sprays, over‐the‐scope‐clips. Paediatric‐specific GIB endoscopic intervention scores are available which help to determine the need or otherwise for early endoscopic haemostatic intervention.

BACKGROUND AND AIMS:The STRIDE-II recommends mucosal healing as a treatment goal for patients with ulcerative colitis (UC), yet histological remission is increasingly recognized as a meaningful therapeutic target. This study aims to evaluate whether histological activity among patients with mucosal healing is associated with the risk of subsequent relapse. METHODS:A multicenter, retrospective cohort study comprised of 19 IBD centers from 9 countries. The study included children diagnosed with UC from January 2012 to December 2022 who had a follow-up endoscopy demonstrating mucosal healing and for whom histology scores were available. Histological remission was defined as a Nancy index (NI) ≤ 1, a Geboes score (GS) ≤ 2, or a Robarts Histopathology Index (RHI) ≤ 3. Histological healing was defined as a histological score of 0. RESULTS:We included 193 children (mean age at diagnosis 10.8 ± 4.3 years; 128 [66%] female). At endoscopy, 155 (80%) children were in histological remission, and 107 (55%) had histological healing. During a median follow-up of 2.4 (range 1-8.7) years, 65 (34%) children experienced a relapse. Patients with histological healing had lower relapse rates than those with residual histological activity (27% vs. 41%; P = .031). Cox regression analysis showed that the absence of histological remission was significantly associated with a higher risk of relapse during follow-up (hazard ratio [HR] 0.499, 95% confidence interval [CI] 0.289-0.863, P = .013), with an even stronger association in those without histological healing (HR 0.469, 95% CI 0.284-0.773, P = .003). CONCLUSION:Histological activity is a risk factor for relapse of UC in children with mucosal healing.

Incidental esophageal eosinophilia (EE) can be detected in children investigated for suspected celiac disease (CD), but the relationship between CD and eosinophilic esophagitis (EoE) remains unclear. This study describes the characteristics of these patients and evaluates whether EE resolves on a gluten-free diet (GFD). This retrospective study included all patients < 18 years biopsied for suspected CD (2018–2025). When esophageal abnormalities were observed, additional biopsies were taken. Cases (CD + EE) had positive antitransglutaminase antibodies—classified as active CD (ACD) or potential CD (PCD) if presented or not intestinal damage- and biopsy-proven EE (≥ 15 eos/HPF). Comparators were randomly selected among CD-diagnosed patients without macroscopical esophageal abnormalities (CD + EE −). Clinical, immunological, and histological features were compared. EE remission (< 15 eos/HPF) was assessed in cases after treatment. PCD patients received proton pump inhibitors (PPIs) for 8 weeks, with GFD prescribed only if PPIs failed. ACD patients received a 6-month GFD first, with PPIs added if esophageal remission was not achieved. 14/520 children (2.7

Background:Infliximab and adalimumab are effective anti-tumor necrosis factor (anti-TNF) therapies for the treatment of pediatric Crohn's disease (CD). The aim of this study was to compare the effectiveness of infliximab and adalimumab in a real-world cohort of children with CD. Methods:Data from biological-naïve children with luminal CD (age 3-18 years) who commenced anti-TNF and completed at least 1 year of follow-up were collected from the prospective multicenter observational PIBD-SETQuality study. The primary outcome was steroid-free clinical remission (SFCR), defined as clinical remission (weighted pediatric Crohn's disease activity index [wPCDAI] <12.5) without systemic steroids or luminal surgery at 1 year. The relative risk (RR) of SFCR was calculated using standardization, correcting for the following baseline covariates: age, upfront anti-TNF, C-reactive protein, erythrocyte sedimentation rate, albumin, leukocytes, disease behavior, wPCDAI, perianal disease, and concomitant immunomodulator use. Secondary outcomes included the durability of anti-TNF treatment without luminal surgery. Results:Between January 1, 2017, and June 14, 2024, 178 patients with anti-TNF were included (infliximab: n = 121 [68%], adalimumab: n = 57 [32%]). At 12 months, 34/56 (61%) patients treated with adalimumab and 66/120 (55%) patients treated with infliximab had reached SFCR. The RR of SFCR at 1 year with adalimumab compared to infliximab was 1.25 (95% confidence interval [CI] 0.94-1.66], P = .13. Adalimumab was associated with a significant lower adjusted hazard ratio (aHR) of treatment discontinuation than infliximab in patients with a concomitant immunomodulator (aHR 0.17 [95% CI 0.04-0.75], P = .020), adjusted for upfront anti-TNF. Conclusions:In this prospective cohort of children with CD, adalimumab and infliximab showed comparable clinical effectiveness 1 year after the start of anti-TNF treatment. Clinical trial registration:The ClincalTrials.gov ID of this study is NCT03571373.

OBJECTIVES:Monitoring for Helicobacter pylori (H. pylori)-eradication is important, since symptom improvement does not indicate treatment success. Using EuroPedHp Registry data, we investigated characteristics of children missing monitoring visits after prescribed therapy, compliance effect on eradication, and factors associated with loss to follow-up and low compliance. METHODS:Between 2017 and 2020, 30 paediatric hospitals from 17 European countries reported 1605 children with biopsy-proven H. pylori-infection. Children with prescribed therapy were analysed. Risk factors for loss to follow-up or low compliance (taking ≤90% of prescribed medications) were identified applying multivariable logistic regression. RESULTS:Of 1263 infected children with prescribed therapy, 390 (31%) were lost to follow-up. Risk factors for loss to follow-up included nausea/dyspepsia (p = 0.004) or gastrointestinal bleeding (p = 0.03) as indication for endoscopy, living in Israel or Türkiye (p = 0.0002), and having no antibiotic susceptibility result (p = 0.004). Risk decreased with living in Southern Europe (p = 0.002), migration background (p = 0.052), and probiotic use during therapy (p = 0.02). Low compliance, reported in 69/831 (8%) children with follow-up data, was associated with vomiting (p = 0.003), peptic ulcers or erosions (p = 0.03), living in EasternEurope (p = 0.009), Israel or Türkiye (p = 0.0008), and any adverse event during therapy (p = 0.0009). First-line tailored triple therapy (TTT) for 14 days (N = 480) was successful in 92% with excellent versus 61% with low compliance (p < 0.0001). After ≥1 failed therapies (N = 60), TTT was successful in 71% with high versus 13% with low compliance (p = 0.003). CONCLUSION:The registry data identified several factors associated with non-adherence to medication and monitoring visits. Improving information to patient/caregiver may increase adherence, care and treatment success.

OBJECTIVES:Autoimmune gastritis (AIG) has been poorly described in childhood. We sought to identify the patterns of manifestations of pediatric AIG at onset and to describe its laboratory, clinical, and histopathological features. METHODS:This was a retrospective, longitudinal, multicenter, cohort study enrolling histologically proven AIG patients with an onset in the pediatric age (<18 years old). We retrieved laboratory and clinical data at the time of onset and at last follow-up when available. Differences between Helicobacter pylori-exposed versus H. pylori-naïve, and anti-parietal cell antibody (PCA)-positive versus PCA-negative patients were investigated. RESULTS:Overall, 51 pediatric AIG patients (median age: 13 years, interquartile range: 11-16; F:M ratio 1.7:1) were included. Most patients were diagnosed with the overt type of AIG (47; 92.1%), while four (7.8%) were still in the potential phase. Atopic dermatitis (9.8%), rhinitis (7.8%), and asthma (5.9%) were common comorbidities, suggesting a link with T helper 2 (Th2) disorders. Two patients (3.9%) were found to have had previous or concurrent eosinophilic esophagitis, and five (9.8%) had eosinophilic gastritis. Notably, four patients (7.8%) presented with collagenous gastritis. On histological examination, the majority of patients were negative for H. pylori infection, except for 1 case out of 51 (2.0%) who had an active infection. CONCLUSIONS:AIG may affect pediatric patients and lead to complications in this population. At presentation, the disease may exhibit histologic patterns attributed to collagenous and/or eosinophilic gastritis. Moreover, a possible association between AIG and Th2 disorders has been observed, warranting further research.

Crohn's disease (CD) is an inflammatory gastrointestinal disorder marked by impaired autophagy due to inefficient bacterial uptake. We studied the effects of autophagy modulation using Tat-beclin-1 and carbamazepine (CBZ) on dendritic cells (DCs) and Paneth cell functionality in pediatric CD patients. Twenty CD children genotyped for the ATG16L1 rs2241880 polymorphism and 10 healthy controls were enrolled. DCs were incubated with fluorochrome-conjugated particles of Escherichia coli or DQ-ovalbumin after pretreatment with CBZ or Tat-beclin-1 to evaluate antigen processing. Treated DCs were stained for P62, LAMP1, and LC3, and analyzed by confocal microscopy. Paneth cells from biopsies were pretreated with both drugs, stained for lysozyme, and analyzed by transmission electron microscopy. Antigen processing increased after Tat-beclin-1 and CBZ treatment in all groups. DCs expressed higher activation markers HLA-DR and CD86+, notably in high-risk patients, who also showed increased DQ-OVA processing. The number of lysozymes in Paneth cells from controls did not change after Tat-beclin-1 treatment, while in the CD group, it decreased significantly, suggesting increased exocytosis. CBZ treatment increased secretory granules only in CD inflamed tissue. Our results indicate that CBZ and Tat-beclin-1 enhance autophagic flux, representing a novel approach to treating pediatric CD patients.

The diagnosis and monitoring of eosinophilic esophagitis (EoE), a common pediatric pathology, typically involves invasive procedures such as an upper endoscopy with biopsies, imposing a significant burden on patients and healthcare systems. We aimed to assess miR-21-5p and miR-223-3p levels in pediatric EoE patients and evaluate their as potential non-invasive biomarkers of disease activity and response to treatments. We enrolled 13 children with EoE and 8 controls. Plasma and esophageal mucosa samples from patients were collected at diagnosis and after 8-10 weeks of therapy and compared with control samples. After microRNA(miRNA) extraction, the levels of miR-21-5p and miR-223-3p and their relevant target genes were analyzed. Bioinformatic analysis was used to identify the predicted target genes and pathways that are potentially relevant for disease pathophysiology. Plasma levels of miR-21-5p and miR-223-3p were significantly higher in EoE patients than in the controls, reflecting their levels in esophageal mucosa. The target genes of these miRNAs are involved in key signaling pathways (MAPK, Ras, and FoxO), relevant for EoE pathophysiology. Among these, STAT3 (Signal Transducer and Activator of Transcription 3) and PTEN (Phosphatase and Tensin Homolog), which are significantly downregulated in patient esophageal mucosa, are implicated in eosinophilic gastroenteropathies and autoimmune diseases. Following therapy (proton pump inhibitors and/or fluticasone propionate), plasma and tissue expression of both miRNAs significantly decreased and were no longer different from the controls. These microRNAs may serve as complementary non-invasive EoE markers and reduce the need for endoscopy/biopsies.

Thiopurines are effective drugs for inflammatory bowel disease, but their use is limited by side effects such as pancreatitis, whose mechanism remains unknown and may be more severe in children. This study investigated in a personalized way thiopurine-induced pancreatitis mechanism using induced pluripotent stem cells from pediatric inflammatory bowel disease patients. Ten pediatric patients, five developing pancreatitis (cases) and five without it (controls), were enrolled. Patient-specific stem cells and their pancreatic differentiated counterparts were used to evaluate thiopurine cytotoxicity, to quantify metabolites levels by liquid chromatography-tandem mass spectrometry, and to assess thiopurine pharmacodynamics by western-blot assay. Statistical analyses were performed applying Student's t-test or two-way ANOVA followed by Bonferroni's post-hoc test for multiple comparisons. Cytotoxicity assays revealed higher thioguanine cytotoxicity in stem and pancreatic cells from cases; pancreatic cells from cases were also more sensitive to mercaptopurine. Moreover, thioguanine treatment on stem cells produced thioguanosine monophosphate and its methylated form, but their concentration did not differ significantly between the groups. In addition, higher TPMT gene expression was observed in stem cells from cases, but no differences were observed in pancreatic cells. No significant differences were detected in HPRT, NUDT15, ITPA, or PACSIN2 expression. Lastly, Rac1 protein concentration was similar in stem cells from cases and controls, but pancreatic cells from cases exhibited significantly higher Rac1 expression. These findings suggest that thiopurine cytotoxicity differences might be linked to pharmacokinetics in stem cells, while altered Rac1 expression in pancreatic cells might contribute to pancreatitis, implicating distinct mechanisms between stem and differentiated cells.

Anaemia is a frequent consequence of many gastrointestinal (GI) diseases in children and it can even be the initial presenting symptom of underlying chronic GI disease. The definition of anaemia is age and gender-dependent and it can be classified based on pathophysiology, red cell morphology, and clinical presentation. Although nutritional deficiencies, including GI malabsorption of nutrients and GI bleeding, play a major role, other pathophysiologic mechanisms seen in chronic GI diseases, whether inflammatory (e.g., inflammatory bowel disease) or not (e.g., coeliac disease and dysmotility), are causing anaemia. Drugs, such as proton pump inhibitors, mesalamine, methotrexate and sulfasalazine, are also a potential cause of anaemia. Not uncommonly, due to a combination of factors, such as iron deficiency and a chronic inflammatory state, the underlying pathophysiology may be difficult to decipher and a broad diagnostic work-up is required. The goal of treatment is correction of anaemia by supplementation of iron and vitamins. The first therapeutic step is to treat the underlying cause of anaemia including bleeding control, restoration of intestinal integrity and reduction of inflammatory burden. The route of iron and vitamin supplementation is guided by the severity of anaemia.

OBJECTIVES:The aim of the study is to evaluate the efficacy of anti-tumor necrosis factor (TNF)-α monotherapy versus combination anti-TNF-α and immunosuppressive therapy. METHODS:A single-center, retrospective, observational study was conducted on inflammatory bowel disease (IBD) children. Patients with at least 6 months of follow-up were enrolled and divided into two groups based on therapy. Combo group included children on combination anti-TNF-α and immunosuppressant therapy; children undergoing anti-TNF-α monotherapy were assigned to Mono group. RESULTS:One hundred and seventeen children were enrolled, of whom 74 (63.2%) were affected by Crohn's disease (CD) and 43 (36.8%) by ulcerative Colitis (UC) (median age at diagnosis: 11.6 years; range 2.1-16.9; M/F: 56/61). Eighty patients (68.4%) were included in combo group and 37 (31.6%) in mono group. The median follow-up was 2.6 years (0.5-11.3). Twenty-three patients out of 80 (28.7%) in Group 1 showed therapy failure compared with 21/37 (56.8%) children in Mono group (p = 0.04). CD patients in monotherapy showed a significantly increased risk of therapy failure than those treated with combination therapy (p < 0.001). Conversely, no difference was found in UC children (p = 0.7). Children undergoing a reactive approach showed more frequent therapy failure compared to proactive in both groups (combo group: 41.7% vs. 4.3%; p = 0.01; mono group: 87.5% vs. 20%; p = 0.01). In a multivariate regression model, the use of a proactive approach and combination therapy was independently associated with anti-TNF-α durability (odds ratio [OR] = 22.1, OR = 12.9). CONCLUSION:Combination therapy reduced overall anti-TNF-α failure in CD children, but not in UC patients. Additionally, a proactive approach was associated with increased anti-TNF-α durability.

The aim of this review is to summarize the prevalence, etiology, pathogenesis, diagnosis, and treatments currently available for small intestinal bacterial overgrowth (SIBO) in children. SIBO is a clinical entity characterized by the presence of an excessive number of bacteria in the small bowel leading to several nonspecific gastrointestinal symptoms due to malabsorption and malnutrition, such as bloating, flatulence, belching, diarrhea, abdominal pain, nausea, steatorrhea, fatigue and stunted growth. Initially thought to develop specifically in the context of abnormal or postsurgical gastrointestinal anatomy, it has then been recognized that it can be associated with other nonsurgical conditions, such as gastrointestinal dysmotility, disorders of gut-brain interactions and chronic use of drugs. The uncertainty regarding the exact cut-off of excessive number of bacteria in the small bowel has led to the absence of a universally accepted definition of SIBO making well-designed research to assess the best diagnostic and therapeutic approaches challenging. Current available diagnostic tools includes duodenal/jejunal aspirate with culture and hydrogen breath tests, which all have some limitations and pitfalls that prevent accurate sampling. The treatment goal should be to treat the underlying causes, restore the healthy intestinal microflora, relieve the symptoms and address the associated complications. The use of antibiotics represents the treatment cornerstore. However, they are commonly used despite the scarce published evidence and the absence of agreement on the dose and duration of the treatment. Currently, data on best diagnostic and therapeutic strategies in children remain lacking. Novel diagnostic approaches for SIBO are emerging and may facilitate further research.

Mucosal healing is the main treatment goal in the management of pediatric inflammatory bowel diseases (IBD), and accurate endoscopic assessment is essential for evaluating disease severity, monitoring progression, and assessing therapeutic responses. However, the wide variability of mucosal lesions, combined with the lack of standardized guidelines and limited training opportunities, complicates the scoring process and contributes to discrepancies in scoring accuracy. To address these issues, a panel of Italian pediatric endoscopists with expertise in IBD, convened by the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP), developed practical recommendations for assessing endoscopic lesions and applying endoscopic scoring systems in pediatric IBD. These guidelines, based on a review of current literature and expert consensus, aim to improve the consistency, reliability, and accuracy of endoscopic evaluations in children with IBD. By providing clear recommendations, the guidelines seek to enhance the reliability of scoring systems, ultimately supporting more effective disease management and treatment outcomes for pediatric patients.

Background and aims Patients with very early-onset inflammatory bowel disease (VEO-IBD), with an age of onset < 6 years, can present with severe manifestations and may require biologic therapy. Infliximab and adalimumab are approved for induction and maintenance in pediatric IBD patients but are licensed only above the age of 6 years. Effectiveness and safety data on adalimumab in this patient population are lacking. We assessed the therapeutic response to help close this gap. Methods This retrospective study involved 30 sites worldwide. Demographic, clinical, and laboratory data were collected from patients with VEO-IBD who commenced adalimumab therapy before the age of 6 years. Results Seventy-eight patients (37 Crohn's disease, 26 ulcerative colitis, and 15 with IBD-unclassified) were included. Median age of IBD onset was 2.6 (1.3-4.1) years, with 30 (38.5%) patients diagnosed at age <2 years. Median age at adalimumab initiation was 4.2 (2.8-5.1) years. Adalimumab was used as second-line biologic therapy in 45 (57.7%) patients after infliximab. The median time to last follow-up was 63 (22-124) weeks. Significant improvement in clinical scores, CRP, fecal calprotectin, and weight Z-score were observed by Week 52. Adalimumab durability rates were 61.9%, 48.1%, and 35.6% after 1, 2, and 3 years, respectively. Drug discontinuation rates were not dependent on IBD type, age, prior anti-TNF exposure, or concomitant immunomodulatory treatment. Four (5.1%) patients developed serious infections, including 1 patient with TTC7A deficiency who died following adenovirus sepsis. Conclusion Adalimumab therapy is a viable therapeutic option in patients with VEO-IBD with an acceptable safety profile.

OBJECTIVES:Functional constipation (FC) is a common problem in childhood and the first-line therapy is macrogol. The role of FC in the onset of inflammatory bowel disease (IBD) is poorly understood. Our main aim was to investigate the prevalence of FC in children before the diagnosis of IBD. METHODS:This is a cross-sectional observational study in pediatric IBD-patients. We collected data on demographics, clinical and endoscopic characteristics at IBD diagnosis, and on the presence of FC and its treatment before IBD diagnosis. RESULTS:A total of 238 children with IBD, 104 (44%) with Crohn disease (CD), 130 (56%) with ulcerative colitis (UC) and 4 (0.016%) with IBD Unclassified (IBD-U) were enrolled. The mean age was 174 ± 47 months, 56% were male. Forty-seven out of 238 (19.7%) had a FC history before the IBD diagnosis and 31 out of these 47 patients (65%) received macrogol therapy. In the FC group, we found a delay in the diagnosis of IBD compared to the group with no FC [median (interquartile range [IQR]): 5 months (2.5-9.5) and 2 months (0-4), respectively, p ≤ 0.001]. The difference in terms of endoscopic localization was statistically significant in UC patients presenting FC (p = 0.026) with a prevalence of proctitis and left side colitis (30% and 15%, respectively). CONCLUSION:In conclusion our study highlighted a prevalence of constipation in pediatric IBD patients at diagnosis of 19.7%, which must be taken into account to avoid diagnostic delay and which is associated with limited extent of disease in UC pediatric patients.