Anyone suffering from inflammatory bowel disease (IBD) needs regular checkups and lifelong care. In one out of four cases they occur during childhood and adolescence, with the classic stomach ache that does not go away and increased frequency of bowel movements due to intestinal inflammation, typical of ulcerative colitis (or colitis) and Crohn’s disease. A critical stage for continuity of care is the transition from pediatric to adult centerssince there is the risk that the young patient “gets lost” and stops following the therapies correctly or even abandons them. Hence the project to favor a planned «transition». (usually around 16-18 years old) promoted byItalian Group for the study of Inflammatory Bowel Disease (Ig-Ibd) together with the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (Sigenp) and the Amici Italia Patients’ Association.
Periods of remission and exacerbation
“These diseases are characterized by periods of remission and periods of flare-up (recurrence) – Paolo Lionetti, full professor at the University of Florence and head of the UOC Gastroenterology and Nutrition of the Meyer pediatric hospital, who 12 years ago set up a transition clinic – began -. There is still no treatment that allows for permanent healing, so I am necessary periodic checks throughout life».
From the preliminary results of a survey conducted by the two scientific societies, involving pediatric and adult care centres, it emerges that there is no uniform transition model. Reports the general secretary of Ig-Ibd Flavio Caprioli, associate professor at the University of Milan and gastroenterologist at the Irccs Foundation Ca’ Granda Ospedale Maggiore Policlinico: «There are transition clinics in which the patient meets the pediatrician and the adult gastroenterologist at the same time; in other cases the patient is sent by the pediatrician to the adult centre where he is visited by the gastroenterologist; in other centres, the transition is not managed”.
Facilitate the transition
How can we concretely facilitate the transition? “It is important to provide adult gastroenterologists with a summary document of the clinical history of young patients – suggests Lionetti -. A transition program must be made that includes at least one joint visit of the boy (with his family) by the pediatric center and that of the adult: initially the two centers can manage the young patient collectively». «Having a structured transitional clinic determines better results both for the maintenance of the remission of the disease and for the patient’s quality of life – Caprioli intervenes -. There continuity of care it is essential, otherwise there is the risk that the young person no longer adheres to medical checks and therapies, which leads to an aggravation of the pathology. Especially in the case of Crohn’s disease sometimes we see a worsening of the pathology without the patient realizing it, since they have few or no symptoms, until suddenly developing a complication and having to resort to hospitalization or surgery».
Hence the need to manage the transition well. “Our project – says Caprioli – in addition to providing an educational program and an information campaign, aims to raise awareness of hospitals and institutions so that clinics dedicated to transition are set up, at least at the treatment centers for kittens”.
With treatments a normal life
«Having a chronic inflammatory bowel disease does not mean being “chronically” ill: today there are treatments that allow the remission of symptoms and a normal life – underlines Paolo Lionetti -. As for the Crohn’s diseaseone of the peculiar problems of the pediatric age is the poor growth, which affects about 40% of young patients; therefore the treatments aim not only to obtain the disappearance of the symptoms,such as abdominal pain and diarrhea, but also to ensure adequate development. For this reason, we use specific liquid diets as a first-line treatment. In selected cases, we start therapy with biological drugs immediately. «As for the rettocolite ulcerosa in the pediatric age – continues the expert – there is a greater frequency of pancolitis (inflammation extended to the whole colon), therefore of serious attacks of ulcerative colitis; in 10-20% of cases, children must be operated on because they do not respond to drug treatment».