ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents

Arie Levine, Sibylle Koletzko, Dan Turner, Johanna C. Escher, Salvatore Cucchiara, Lissy De Ridder, Kaija Leena Kolho, Gabor Veres, Richard K. Russell, Anders Paerregaard, Stephan Buderus, Mary Louise C. Greer, Jorge A. Dias, Gigi Veereman-Wauters, Paolo Lionetti, Malgorzata Sladek, Javier Martin De Carpi, Annamaria Staiano, Frank M. Ruemmele, David C. Wilson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

946 Scopus citations


BACKGROUND:: The diagnosis of pediatric-onset inflammatory bowel disease (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 using 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 while 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 2 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 (IBD-U) is proposed. Specifically, these revised criteria recommend upper gastrointestinal endoscopy and ileocolonscopy for all suspected patients with PIBD, with small bowel imaging (unless typical UC after endoscopy and histology) by magnetic resonance enterography or wireless capsule endoscopy. CONCLUSIONS:: These revised Porto criteria for the diagnosis of PIBD have been developed to meet present challenges and developments in PIBD and provide up-to-date guidelines for the definition and diagnosis of the IBD spectrum.

Original languageAmerican English
Pages (from-to)795-806
Number of pages12
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number6
StatePublished - Jun 2014
Externally publishedYes


  • Crohn disease
  • Diagnosis
  • Inflammatory bowel disease
  • Inflammatory bowel diseaseunclassified
  • Ulcerative colitis


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