MondayNightIBD

Back2Basics & #IBD Algo
🎯Very early onset IBD #Crohns #UlcerativeColitis #VEOIBD
With #DrDavidLevine @gut.md_ & @gutsglory.md

🧒🏻Definition: Age on onset <6
🔺Make up 15% of all PedsIBD
🧬~15-20% having a monogenic cause — especially infants <age 2
📈 VEO-IBD is on the rise

💎 Dz location: Colon ++ (94%); isolated ileal disease rare
🔬 Histology clues — eosinophilic infiltrates, ⬆️apoptosis; villous blunting/atrophy, ⬆️IEL — can point to monogenic disease
⏰💎All pts should get genetic evaluation

⏰⬇️ Response to TNFi in VEOIBD vs in older kids
✅ IFX 3-yr maintenance 12% VEOIBD vs 67% in REACH trial
💎 Recommendations to ⬆️ réponse to IFX:
✅ Body Surface Area-based dosing (200 mg/m²) + tight TDM
✅🎯 IFX levels: >23 before 2nd infusion, >10 @ maintenance

🧬Monogenic VEOIBD management
💎 Genetic mutation guides targeted therapy, identify CI to drugs
✅ Abatacept for CTLA4/LRBA deficiency
✅ Anti-IL18 for NLRC4
✅ Rapamycin for FOXP3/PIK3CD before HSCT
✅ Hematopoietic stem cell transplant
🚨💎Critical: AVOID TNFi in CGD
🚨💎Hematopoietic stem cell transplant is potentially curative !

Supported by educational grants @abbvie @jnjinnovativemedicine and Takeda Pharma