INFLAMMATORY BOWEL DISEASE IN PEDIATRIC AND ADOLESCENT PATIENTS
Section snippets
EPIDEMIOLOGY
Since the 1930s, the incidence of IBD has greatly increased. In the 1950s, UC was twice as prevalent as CD, but studies in the United States show that CD has been steadily increasing.14 The age-specific incidence rates in North America for 10- to 19-year-olds are approximately 2:100,000 for UC and 3.5:100,000 for CD.6 The incidence of CD has increased in the pediatric age group with approximately 4% presenting before 5 years of age. Most studies have reported an equal incidence of CD in boys
Ulcerative Colitis
UC is a diffuse mucosal inflammation limited to the colon. It invariably affects the rectum and may extend proximally in a symmetric uninterrupted pattern to involve parts or all of the large intestine. Because UC is a mucosal disease limited to the colon, the most common presenting symptoms are rectal bleeding, diarrhea, and abdominal pain. Langholz et al37 reported that at diagnosis children with UC had more extensive disease than did adults. Abdominal pain was also more common. The
GASTROINTESTINAL COMPLICATIONS
CD and UC are both associated with significant gastrointestinal complications. The major intestinal complications of UC are massive bleeding, toxic megacolon, and carcinoma. In contrast, the major intestinal complications of CD are due to the transmural nature of the disease. This nature leads to the formation of abscesses, fistulas, strictures, and adhesions, which may also contribute to the development of obstruction or bacterial overgrowth.
The most serious acute complication of UC is toxic
EXTRAINTESTINAL MANIFESTATIONS
Twenty-five percent to 35% of patients with IBD have at least one extraintestinal manifestation. These diseases may be diagnosed before, concurrently with, or after the diagnosis of IBD is made.8 Extraintestinal manifestations can occur even after colectomy for UC. The presence of extraintestinal manifestations may carry prognostic significance. Patients with UC and extraintestinal manifestations have a significantly higher rater of pouchitis after colectomy and ileoanal anastomosis.29
Skin
GROWTH FAILURE
Growth failure and delayed sexual development are common problems in adolescents and children with CD.4 Studies have evaluated the growth of children with CD, and it is clear that impairment of linear growth is common before diagnosis as well as during subsequent years and that height at maturity is often compromised.19 Height velocity is the most sensitive parameter by which to diagnose impaired growth and to follow the effects on growth after therapy. Kanof et al34 reported a decrease in
DIAGNOSIS
The initial evaluation of suspected IBD should be performed by the primary physician. The importance of the history cannot be overemphasized. Recent antibiotic intake and family history are important and often overlooked. Abdominal examination is often nonspecific, although a fullness or mass in the right lower quadrant may indicate CD. Rectal examination is important to detect perianal disease and fecal blood. A careful assessment of growth and development is an important part of the
DIFFERENTIAL DIAGNOSIS
The diagnosis of IBD is often difficult because of the subtle manner in which it may present. Recurrent abdominal pain is a common problem in pediatrics, with 10% of all children complaining of nonspecific periumbilical pain at some time during childhood. Recurrent abdominal pain in children with IBD is generally associated with other problems, such as anorexia, growth failure, decreased appetite, diarrhea, or extraintestinal manifestations. Therefore, children with abdominal pain and any of
MANAGEMENT
The general goals of treatment for children with IBD are to
- 1
Achieve the best possible clinical and laboratory control of the inflammatory disease with the least possible side effects from medication
- 2
Promote growth through adequate nutrition
- 3
Permit the patient to function as normally as possible (e.g., school attendence, participation in sports)
Not all of these goals are always attainable.
The treatment of IBD has changed greatly over the past few years with the development of new agents that
SUMMARY
IBD is a chronic pediatric disease that needs to be treated by a team of experts consisting of pediatricians, pediatric gastroenterologists, psychologists, nutritionists, social workers, and nurses. A critical factor in successful management of this disease is the willingness of the patient to participate and cooperate with the team. Parents and patients must be educated and supported to treat these disorders effectively. Much further research is necessary to understand the specific causative
References (62)
- et al.
Sclerosing cholangitis in children
J Pediatr
(1994) - et al.
Incidence rates of ulcerative colitis and Crohn's disease in 15 areas of the United States
Gastroenterology
(1981) - et al.
Inflammatory bowel disease in childhood and adolescence
Pediatr Clin North Am
(1975) - et al.
Prognosis in children with Crohn's disease
Gastroenterology
(1978) - et al.
Budesonide edema for the treatment of active, distal ulcerative colitis and proctitis: A dose-ranging study
Gastroenterology
(1998) - et al.
Inflammatory bowel disease in children
Med Clin North Am
(1994) - et al.
Clinical outcome of ulcerative colitis in children
J Pediatr
(1996) - et al.
Single toxin detection is inadequate to diagnose Clostridium difficile diarrhea in pediatric patients
Gastroenterology
(1998) - et al.
Inflammatory bowel disease presenting as liver disease during childhood
J Pediatr
(1980) - et al.
Urolithiasis complicating inflammatory bowel disease
J Urol
(1992)
Crohn's disease: Influence of age at diagnosis on site and clinical type of disease
Gastroenterology
Azathioprine in the treatment of children with inflammatory bowel disease
J Pediatr
Inflammatory bowel disease
Effect of enteric-coated fish oil preparation on relapses in Crohn's disease
N Engl J Med
Toxic megacolon in ulcerative colitis
Gastroenterology
The nutritional consequences of gastrointestinal disease in adolescence
Acta Pediatr Scand
Clinical manifestations of Crohn's disease in children and adolescents
Pediatrics
Tends in incidence rates of ulcerative colitis and Crohn's disease
Dig Dis Sci
Historical notes
Clin Gastroenterol
Extraintestinal manifestations of idiopathic inflammatory bowel disease
Arch Intern Med
Cancer risk and life expectancy of children with ulcerative colitis
N Engl J Med
Ulcerative colitis and colorectal cancer: A population-based study
N Engl J Med
Prognosis of Crohn's disease with onset in childhood or adolescence
Dig Dis Sci
Toxic megacolon in ulcerative colitis and Crohn's colitis
Clin Gastroenterol
Autoimmune hepatitis in childhood: A 20-year experience
Hepatology
Slow-release 5-aminosalicylic acid therapy in children with small intestinal Crohn's disease
J Pediatr Gastroenterol Nutr
Crohn's disease
Rec Adv Pediatr
Growth and clinical course of children with Crohn's disease
Gut
Colonoscopic surveillance for cancer in ulcerative colitis: A critical review
J Pediatr Gastroenterol Nutr
Colonoscopy in childhood
Pediatrics
Longitudinal growth in children and adolescents with inflammatory bowel disease
J Pediatr Gastroenterol Nutr
Cited by (182)
Systematic review: Sarcopenia in paediatric inflammatory bowel disease
2023, Clinical Nutrition ESPENGastrointestinal Disorders in Adolescents and Young Adults: Preparing for a Smooth Transition to Adult-Centered Care
2022, Gastroenterology Clinics of North AmericaPrecision Medicine in Pediatric Inflammatory Bowel Disease
2021, Pediatric Clinics of North AmericaCitation Excerpt :Inflammatory bowel disease (IBD) has been rising in prevalence across the world since the start of the industrial revolution,1 and IBD is diagnosed before the age of 20 in about a quarter of patients, making it commonly a disease of childhood.2
Inflammatory bowel disease in primary immunodeficiency disorders is a heterogeneous clinical entity requiring an individualized treatment strategy: A systematic review
2021, Autoimmunity ReviewsCitation Excerpt :Early recognition of PID-associated IBD could result in earlier treatment and even reduce diagnostic delay for PID. In general, IBD comprises two types of chronic inflammatory disorders of the gastrointestinal tract: ulcerative colitis (UC) and Crohn's disease (CD) [9]. Distinct features may differentiate between both conditions, including disease phenotype, localization, endoscopic and histologic features.
Infantile inflammatory bowel disease in three Syrian infants: a case series
2024, Journal of Medical Case Reports
Address reprint requests to Robert N. Baldassano, MD, The Children's Hospital of Philadelphia, Division of Gastroenterology and Nutrition, 34th & Civic Center Boulevard, Philadelphia, PA 19104