From Genes to Gut: Understanding Diagnosis and Treatment in Very Early Onset Inflammatory Bowel Disease

Very early onset inflammatory bowel disease (VEO-IBD), defined by a diagnosis of IBD before age 6 years, poses unique clinical and therapeutic challenges. This review examines differences in clinical manifestations and management for this population, noting important considerations between polygenic and monogenic forms of VEO-IBD. In general, a younger age of onset of IBD is associated with more extensive disease burden and more guarded outcomes compared with adults. For this reason, a comprehensive and multidisciplinary approach involving pediatricians, gastroenterologists, dietitians, and immunologists, among other subspecialties, is vital. Early identification of monogenic disease may allow for targeted therapy selection and improved prognosis, so a high index of suspicion from caretakers is needed. Moving forward, more real-world descriptions, prospective trials, and emerging studies on gene therapy and new mechanisms of action offer promise with a goal for a precision-based approach in this unique population.