Inflammatory bowel disease in paediatrics: Navigating the old challenges and emerging frontiers

Table 3 Comparison of paediatric vs adult-onset inflammatory bowel disease

Feature	Pediatric-onset IBD	Adult-onset IBD
Disease extent	More extensive disease (e.g., pancolitis in UC, panenteric CD)	More localized (e.g., left-sided colitis in UC)
Severity at onset	Often more severe with rapid progression	Variable; may have a milder course at onset
Growth and development	Commonly affected (growth failure, delayed puberty, bone density loss)	Growth is not an issue
Perianal disease	More common in pediatric Crohn’s disease	Less frequent
Extraintestinal manifestations	More frequent and severe	Present, but generally less common
Disease behavior over time	More aggressive with higher risk of complications (stricturing, penetrating)	Slower progression in many cases
Response to therapy	Often good response, but long-term therapy and toxicity concerns	Shorter treatment duration; toxicity concerns more manageable
Psychosocial impact	High impact on quality of life, schooling, and emotional development	Significant, but generally with better coping mechanisms
Treatment adherence	More challenging, especially during adolescence	Usually, better self-management and adherence

CD: Crohn’s disease; UC: Ulcerative colitis; IBD: Inflammatory bowel disease.