ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

Abstract

BACKGROUND:: The diagnosis of pediatric-onset IBD (PIBD) can be challenging in choosing the most informative diagnostic tests and correctly classifying PIBD into its different subtypes. Recent advances in our understanding of the natural history and phenotype of PIBD, increasing availability of serological and fecal biomarkers, and the emergence of novel endoscopic and imaging technologies taken together have made the previous Porto criteria for the diagnosis of PIBD obsolete. METHODS:: We aimed to revise the original Porto criteria utilizing an evidence-based approach and consensus process to yield specific practice recommendations for the diagnosis of PIBD. These revised criteria are based on the Paris classification of PIBD and the original Porto criteria whilst incorporating novel data, such as for serum and fecal biomarkers. A consensus of at least 80% of participants was achieved for all recommendations and the summary algorithm. RESULTS:: The revised criteria depart from existing criteria by defining two categories of ulcerative colitis (UC; typical and atypical); atypical phenotypes of UC should be treated as UC. A novel approach based on multiple criteria for diagnosing IBD-unclassified (IBDU) is proposed. Specifically, these revised criteria recommend upper GI endoscopy and ileocolonscopy for all suspected PIBD patients, with small bowel imaging (unless typical UC after endoscopy and histology) by magnetic resonance enterography (MRE) or wireless capsule endoscopy. CONCLUSIONS:: These revised Porto criteria for the diagnosis of PIBD have been developed to meet current challenges and developments in PIBD and provide up to date guidelines for the definition and diagnosis of the IBD spectrum