Crohn's disease (CD) is a chronic non-specific inflammatory disease of the digestive tract, which was first reported in detail by Crohn in 1932 as “regional ileitis”, and was later formally named Crohn's disease by the medical community in honor of Dr. Crohn. Crohn's disease was first reported in detail by Crohn in 1932. The incidence of the disease has been on the rise globally and has gradually evolved into a global disease, especially in countries where the incidence of the disease was relatively low in the past (1, 2). Crohn's disease has received a lot of attention from scholars around the world, especially in countries where the incidence was previously low. Crohn's disease has no fixed age group, but up to a quarter of Crohn's patients are children (3). The etiology of Crohn's disease (CD) in children is unclear and may be related to environmental factors, genetic factors, immunologic factors, infections, and intestinal flora disorders. Clinical manifestations are characterized by chronic, recurrent gastrointestinal symptoms such as abdominal pain, diarrhea, and blood in the stool, as well as extra-intestinal symptoms such as malnutrition, short stature, developmental delays, and suboptimal bone health (4–6). Due to its seriousness and prolonged course, it seriously affects children's health and quality of life. Children and adolescents with Crohn's disease (CD) tend to have a more complex course than adult patients, and this chronic inflammatory disease not only has a greater impact on the physical health of the children themselves, but also poses a significant challenge to their families in terms of mental health and long-term therapeutic management. A large number of articles have been published on Children and adolescents with Crohn's disease (CD). However, there is a lack of studies that use visualization methods for bibliometric analysis of relevant literature. The aim of this study was to characterize the literature output on Crohn's disease comprehensively between 2014 and 2024 through bibliometric analysis, to identify the hotspots and frontiers of research, and to provide new ideas and references for future clinical and research work.

Bibliometrics refers to the use of mathematical and statistical methods to mine the information of a subject area, after we sort out and summarize the information we get, we use visual data and charts to express the history of research, research status, research hotspots and development trends of the subject, so that the researchers can have a more direct understanding of the results of the research of the subject area.Citespace and VOSviewer are both software tools to build and visualize the network of bibliometrics. Citespace and VOSviewer are both software tools for building and visualizing bibliometric networks; Citespace generates a “scientific knowledge graph” through econometric analyses of literature in a specific field, helping us to understand the past research trajectory and future research prospects of the subject area (7–9). Vosviewer can be constructed based on citations, co-occurrences, co-authors, bibliographic couplings, and collaborations, and can also construct and visualize co-occurrence networks of important terms extracted from the vast scientific literature (10, 11). It can also build and visualize co-occurrence networks of important terms extracted from large amounts of scientific literature. In recent years, bibliometrics and visual analytics have been widely used in the field of medicine.The Web of Science Core Collection (WOS) is the world's largest comprehensive multidisciplinary core journal database. To the best of our knowledge, no bibliometric analysis of Crohn's disease in children has been reported through the above authoritative databases.

In this study, we used Citespace (6.2.R4) and VOSviewer (1.6.18) to statistically analyze and visualize literature related to childhood CD in the WOS Core Collection database from 2014 to 2024. Our ultimate goals were mainly (i) to identify influential countries, institutions, authors and journals that have made outstanding contributions to the field of pediatric CD; (ii) to shed light on the current status, hotspots and future trends of research; and (iii) to promote collaborative research among scholars globally in the hotspot and bottleneck areas of pediatric CD.

This study is the first to use CtieSpace and VOSviewer to visualize and analyze the literature in the field of pediatric Crohn's disease and to summarize the research frontiers and hotspots in the field. A total of 3,177 publications from January 1, 2014 to August 2, 2024 were collected for this study. The publication trend of the literature is an overall upward trend showing a steady increase, in which the publication of the literature in 2021 reached the highest number of 370 articles in the past 10 years, and since then there are fluctuations in the literature published every year, but still at a high level, indicating that the researchers' enthusiasm for research in this field is only increasing.

Turner, Dan is the first author with the highest number of publications and the second most cited author with more research on biomarkers of CD and treatment with biologics (metabolism and monoclonal antibodies) (12–17). The first author with the highest number of citations is Levine, A. Levine, A and his team showed that exclusion of dietary therapy with or without enteral nutrition may induce clinical remission in Crohn's disease (18, 19).

The United States and Canada are both highly productive countries in the field of pediatric CD. Because the disease is closely related to the dietary structure of developed countries, the number of cases in these two countries is high, which has prompted them to carry out profound research on the disease and produce quite fruitful results. Looking at the top ten countries in the publication, eight of them belong to European and American developed countries, and only two are from Asian countries, of which only China is a developing country. With the globalization of the disease, European and American developed countries should strengthen the cooperation and contact with Asian and African countries, so as to provide more comprehensive and cutting-edge diagnostic and treatment guidelines for children with CD. Among the top ten institutions, the sources show that they are also monopolized by the United States, Canada and Israel, with six institutions from the United States, 20% from Canada and 20% from the United States, and Tel Aviv University from Israel occupying the first place, which shows that this institution pays more attention to children with CD and contributes to the research in the field of children with CD. Combined with the literature, we know that North America and Europe have the highest prevalence rates, which are still increasing or stable, while the newly industrialized countries in Asia, the Middle East, and Africa are also experiencing an increase in prevalence rates (2). The incidence is also increasing in newly industrialized countries in Asia, the Middle East, and Africa. We have found that because developing countries have fewer cases than developed countries, developed countries have more experience and foresight in the study of this disease, but with the globalization of CD in children, global coordination should be encouraged, and developing countries should strengthen their cooperation with developed countries in order to promote the development of research in the field of CD in children, and to construct more authoritative and comprehensive guidelines, rather than geographically specific consensus and guidelines. The following is a summary of the recommendations of the study.

The top-ranked journal, Journal Of Pediatric Gastroenterology And Nutrition, IF 2.4 Q3, published 396 articles on pediatric CD. Only one of the top ten journals has an IF lower than 2, and six journals are in JCR division 1, indicating that the research on pediatric CD is a hot topic of global concern, the overall academic level is high, and the results of the research are authoritative and instructive.

The most cited literature is ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents, an article that takes an evidence-based and consensus approach using a robust methodological approach to the Porto criteria was revised and a new approach to diagnosing IBD-unclassified (IBD-U) based on a multi-criteria approach was presented (20). The second most frequently cited article was Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease, which was co-authored by ECCO/ESPGHAN using a benefit-risk analysis-based individualized treatment algorithm for Children and adolescents with Crohn's disease (CD) medication and long-term management to provide the most up-to-date state-of-the-art guidance. In children and adolescents with incomplete growth, exclusive enteral nutrition (EEN) is the treatment of choice for induction therapy, and the majority of patients with childhood-onset CD require maintenance therapy based on immunomodulators.This guideline only provides an approximate direction for treatment, but because there are so many different clinical scenarios, it should be individualized in treatment (21). The article with the highest intensity of outbreaks was The Medical Management of Paediatric Crohn's Disease: an ECCO-ESPGHAN Guideline Update, which provides a review of a 2014 article published in the Journal of Crohns &amp Colitis, which updates the consensus guidelines on Children and adolescents with CD published in 2014, with highlights of the update including: proposing new goals for the treatment of Crohn's disease in children; advocating for the optimization of individualized treatment regimens and proposing risk stratification; and developing different induction and maintenance treatment regimens for different risk strata of children (22). The update highlights the following.

The frequency and centrality of keywords shows that the therapeutic aspect dominates pediatric CD research, with drug therapy, immunomodulators, corticosteroids, biologics, surgical therapy, other therapies (enteral nutrition), etc (3, 23). Under a variety of therapies, enteral nutrition therapy has become the center of attention.

Enteral nutrition includes total enteral nutrition (EEN) and partial enteral nutrition (PEN), with total enteral nutrition standing out amongst the various approaches because of its significant remission-inducing effect and the absence of virtually all medical side effects (21, 24, 25). It stands out among the various approaches as the first-line agent for inducing remission in active pediatric Crohn's disease, with typical remission rates of up to 85% (26). Studies have shown that EEN therapy can induce remission in children with active Crohn's disease. Studies have shown that EEN therapy induces mucosal healing, promotes growth and significantly improves nutritional parameters, improves bone mineral density, alters intestinal flora, enhances barrier function and has a direct anti-inflammatory effect (26, 27). Although EEN has better clinical remission, the method requires extreme family cooperation, which is challenging for the average family. Considering that the treatment of CD in children needs to be individualized, we should take into account multiple factors, such as age, site of disease, disease behavior, the presence of growth delays, potential side effects of medications, and quality of life. A key point in developing an optimal treatment plan is how to identify high-risk patients with a complex disease course, with the overall goal of rapid control of inflammation and reduction of long-term intestinal damage. It is therefore the responsibility of each clinician to adapt these guidelines to local regulations as well as to the individual characteristics and needs of the patient.

No researcher has published a bibliometric analysis of pediatric CD research. This study summarizes comprehensive information and hot frontiers in CD from the perspective of bibliometric analysis using Citespace (6.1.R6) and VOSviewer (1.6.18) to provide a meaningful reference for research in this field. This study is not perfect and has limitations. First, there may be subjectivity in manually screening the included literature. Second, we retained only English literature. Finally, VOSviewer and CiteSpace do not support advanced statistical analysis, which may introduce statistical bias. However, these limitations do not affect the extraction and analysis of comprehensive information in the field of children's CD.

The bibliometric analysis of this study presents comprehensive information on articles in the field of pediatric CD over the last decade. We found that pediatric CD research is undergoing a rapid development phase, with more and more countries, institutions and researchers taking a keen interest in pediatric CD. Although results continue to emerge, the treatment of pediatric CD remains a pressing issue and a focus for future research. We summarize and propose innovations for global collaboration in pediatric CD. We hope that the “country-institution-journal” model of collaboration will help researchers and clinicians make more extraordinary breakthroughs in this field.