In the last several years, inflammatory bowel disease (IBD) has been extensively characterized, resulting in efficient (but not harmless) therapies such as with anticytokine biologicals. In spite of this remarkable progress, the pathogenesis is still confusing, but on a higher level, and a therapy to control or, better, to cure this chronic inflammation is still a long way off. The complexity of IBD is especially challenging in children—is the pathogenesis, genetics (CARD15, tumor necrosis factor-a 308 A) (1,2), immunology, diagnosis and therapy of IBD not heterogeneous enough? Even in its clinical presentation, IBD heterogeneity is broader than previously known. Although children with IBD have been studied more systematically, with the establishment of registries, it has become obvious that younger children seem to present with special features (3,4). In this issue of the Journal of Pediatric Gastroenterology and Nutrition, Ruemmele et al. (5) analyse the data of 10 infants with onset of IBD in the first year of life, adding a small but important stone to the mosaic of IBD. Compared with older IBD patients, there was a predominance of colonic involvement (with rectal bleeding) in all patients. Furthermore, but not surprisingly, this patient group required (1) more aggressive therapeutic efforts to achieve remission, (2) parenteral nutrition, (3) the application of steroids, azathioprine and cyclosporine medication, (4) more surgical interventions, and (5) had more relapses. The authors carefully looked for pathogenetic factors such as bacterial infections, use of antibiotics before disease onset and breastfeeding among others, but the study group was too small to find any significant data about them. The average duration of breastfeeding was 2 months in the patients in the Ruemmele et al. study. These factors need to be readdressed in larger cohorts. Because of the progression of the clinical manifestations
[1]
O. Goulet,et al.
Characteristics of Inflammatory Bowel Disease With Onset During the First Year of Life
,
2006,
Journal of pediatric gastroenterology and nutrition.
[2]
K. Siala,et al.
Cytokine Tumor Necrosis Factor-alpha A Promoter Gene Polymorphism at Position −308 G→A and Pediatric Inflammatory Bowel Disease: Implications in Ulcerative Colitis and Crohn's Disease
,
2006,
Journal of pediatric gastroenterology and nutrition.
[3]
M. L. Forchielli,et al.
The effect of protective nutrients on mucosal defense in the immature intestine
,
2005,
Acta paediatrica (Oslo, Norway : 1992). Supplement.
[4]
R. Baldassano,et al.
Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry.
,
2005,
The Journal of pediatrics.
[5]
M. Stolte,et al.
Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine
,
2004,
Gut.
[6]
I. Sanderson.
The innate immune system of the gastrointestinal tract.
,
2003,
Molecular immunology.
[7]
A. Rösen‐Wolff,et al.
CARD15 Genotype and Phenotype Analysis in 55 Pediatric Patients With Crohn Disease From Saxony, Germany
,
2003,
Journal of pediatric gastroenterology and nutrition.
[8]
Steven R. Martin,et al.
Outcome of Crohn's disease diagnosed before two years of age.
,
2002,
The Journal of pediatrics.
[9]
M. Burdelski,et al.
Th2 cytokine profile in infants predisposes to improved graft acceptance after liver transplantation.
,
2001,
Transplantation.
[10]
Mourad Sahbatou,et al.
Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease
,
2001,
Nature.