THE ROLE OF TRANSITION IN THE CARE OF PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE PATIENTS
Tóbi Luca
Clinical Medicine
Dr. Reusz György
Semmelweis Egyetem I. sz. Gyermekgyógyászati Klinika Koós Aurél terem
2025-02-25 14:00:00
Prevention of Chronic Diseases in Childhood
Dr. Szabó Attila
Dr. Cseh Áron
Dr. Patai Árpád
Dr. Golovics Petra
Dr. Szabó Dóra
Dr. Egresi Anna
Dr. Szűcs Dániel
Despite 25% of every IBD having a pediatric onset, there are no established transitional guidelines and the existing recommendations are mostly based on expert opinions, single-center studies, and being extrapolated from other disciplines.
Our longitudinal, follow-up, controlled clinical study incorporated a retrospective and prospective data collection period of 20 years, including 351 PIBD patients, of whom 73 were enrolled in our transitional program, whereas 79 self-transferred to adult care and served as our control group. We aimed our study to examine the clinical determinants of a successful transition and define the objective and measurable effects of the changing process from pediatric to adult care on the disease course, activity, and patient compliance, including the comparison of a structured transitional program with self-transfer. Furthermore, we wanted to determine the unique characteristics of PIBD patients, that require special attention in adult care.
Transition was positively associated with lower disease activity, fewer relapses, better medication adherence, and a lower lost-to-follow-up rate as opposed to self-transfer. Enrollment in our structured transitional program was shown to be the only significant protective factor in adherence to medical care after the initiation of transfer to adult care. The changing process to adult care caused a deterioration in both medical adherence and overall compliance of the patients, with a high lost-to-follow-up rate, in which the female gender was a risk factor. PIBD patients had an extensive and medically complex disease upon arriving at adult care, with a history of former surgeries and IBD-related complications, high rates of malnutrition, growth impairment, and poor bone health, and with their compliance worsening with both higher age and longer disease duration.
To our knowledge, our study has the highest number of patients enrolled in a structured transitional program with a comparable control group, that examined the objective and measurable clinical outcomes with a long follow-up period. The results of our study correspond to the current state of literature and emphasize the critical role of a structured transition in providing the best possible disease outcome for PIBD patients.
