Pediatric inflammatory bowel disease Monitoring, nutrition and surgery

Inflammatory bowel disease (IBD) is a debilitating group of inflammatory conditions of the gut. Children suffering from IBD, especially in the case of an uncontrolled disease course, are prone for impairment of physical and mental development.
Therefore, PART I of this thesis focuses on monitoring disease course on several aspects, being symptoms, the actual inflammation of the gut measured with biomarkers, and the interrelationship between both. Here we investigated both a concurrent correlation of symptoms and inflammation, as well as the predictive capacity of biomarkers of inflammation and future relapse of symptoms. Moreover, we inquired the potential effect of disease course on the whole family, from quality of life of the child to perceived stress by their parents.
Nutrition is needed in times of high consumption due to illnesses like IBD, but can also serve as treatment, particularly in children with Crohn’s Disease (CD). In PART II of this thesis, the habitual diet of children with IBD under medical guidance was studied. In addition, the effect of exclusive enteral nutrition (EEN) on the gut microbiota and metabolomic profile of children with CD was measured, attempting to unravel the mechanism of this effective but mechanistically unclear therapy.
When IBD is refractory to therapy, a surgical intervention may be considered or even be the only option in case of acute severe disease not responding to rescue medication. In PART III of this thesis, children with IBD who underwent a (segmental) gut resection were reviewed for short and long-term adverse outcomes. Making use of national pediatric IBD research collaborations and in contrast to most pediatric IBD studies on surgical interventions, relatively large cohorts could be collected and investigated.