Inflammatory Bowel Disease (IBD)
What is it?
Inflammatory Bowel Disease (IBD) is the most
common chronic gastrointestinal illness in
children and adolescents. About 1/3 of all
persons with IBD have the onset of their illness
before adulthood.
IBD consists mainly of two conditions –
Ulcerative Colitis and Crohn’s disease.
Ulcerative colitis (UC) is an inflammatory
disease of the large intestine (colon). It is
characterized by inflammation and ulceration of
the innermost lining of the colon. Because the
bowel is so inflamed, persons with ulcerative
colitis experience diarrhea which is often mixed
with blood. Urgency to have a bowel movement also
occurs. A child or adolescent may have great
anxiety about being able to reach a bathroom
"in time". Abdominal pain is also a
common symptom. Some young persons also
experience pain in their knees, ankles, and other
joints.
In about half of persons with UC, the disease
affects only the lowest part of the colon (called
the rectum). The inflammation of the bowel occurs
in the rectum (called proctitis) and may extend
up the colon in a continuous manner.
Crohn’s disease (CD) is a condition in which
the wall of the small or large intestine becomes
sore, inflamed, and swollen. In children and
young adults, this causes abdominal pain,
diarrhea, fever, and weight loss. Joint pain may
also be present.
Crohn’s disease can affect any area of the
gastrointestinal tract, from the mouth down to
the anus. The inflammation may be
"patchy" with segments of healthy
tissue between the patches. The area most
frequently affected by Crohn’s disease is the
end of the small intestine and the large
intestine.
Who gets it?
It is estimated that there are almost two
million Americans with IBD. The northern tier of
U.S. states has a higher incidence than the rest
of the country.
The peak age at onset is between 10-30 years.
About 25% of all patients are younger than 20
years old. Males and females are affected almost
equally. There is a higher incidence in persons
of Ashkenazic Jewish (Eastern European) ancestry.
IBD tends to run in families. When one family
member has IBD, there is a 15-30% chance that
there is another affected family member (first
cousin or closer relation).
What are the symptoms?
The symptoms of ulcerative colitis, and
particularly Crohn’s disease, in children may
be vague. A wide range of symptoms may be
present. A delay in diagnosis is common, as many
of the symptoms do not suggest IBD at first.
In children, there are many other types of
inflammatory bowel diseases that are not CD or UC.
For instance, bacterial or parasitic infections
of the bowel that cause inflammation are common
at all ages; they are much more common than IBD
in young children. These other causes of bowel
inflammation must be considered, as most of them
are curable with therapy.
Bloody stools and diarrhea are common symptoms
of UC in children and adolescents. Most also have
abdominal pain; the pain may be located over the
lower left side of the abdomen. Fatigue, loss of
appetite, and weight loss are common symptoms.
The most common symptoms of pediatric CD are
diarrhea, abdominal pain and fever. The abdominal
pain may be located over the right lower side of
the abdomen. CD is sometimes diagnosed when a
child develops pain that appears to be
appendicitis. Loss of appetite and nausea may be
present. Parents should be alert for persistent
diarrhea and weight loss in children of this age
group. A downward trend on children’s’ growth
charts may be noticed when they visit the
pediatrician’s office.
How is it Diagnosed?
There is no known cause of IBD and it cannot
be prevented. Ongoing research is looking at IBD
as a condition with many factors. Areas of
research include genetics and environmental
causes. Some studies indicate that IBD may be
linked to an unknown bacteria or virus. Research
has also indicated that persons with IBD may have
an alteration in their immune system.
IBD is not contagious. It can not be spread
among children.
Is IBD the same as Irritable Bowel syndrome
(IBS)?
Many people confuse IBD and IBS. Both
conditions tend to occur in young adulthood.
However, IBD and IBS are very different
conditions.
Irritable bowel syndrome is commonly known as
"spastic colon". IBS is also a chronic
disorder of the gastrointestinal tract. It is
characterized by altered bowel habits (diarrhea
and/or constipation), abdominal pain, and
gaseousness. The hallmark of IBS is that the
abdominal pain is relieved with a bowel movement.
Although the symptoms of IBS can be distressing,
there is no bowel inflammation with IBS. All
diagnostic studies will be normal with IBS.
What should I do if I think my child has IBD?
Talk with your healthcare provider. If your
child has symptoms of IBD, your healthcare
provider should discuss the symptoms openly with
your and your child. A thorough physical
examination should be done. She/he will probably
also order some blood tests to check for an
inflammatory process or anemia. Referral to a
pediatric gastroenterologist is warranted if the
child’s symptoms and the blood work suggest IBD
or are inconclusive.
Other studies will need to be done to diagnose
IBD, Specific x-ray studies, such as an upper
gastrointestinal series (upper GI) and/or barium
enema may be necessary for diagnosis.
An endoscopic procedure to exam the small or
large bowel is an essential test to determine if
a child or adolescent has IBD. These procedures
involve passing a thin flexible scope into the
intestinal tract so that it can be evaluated for
signs of IBD. Samples of the intestinal lining,
called biopsies, can be obtained during these
tests.
Even with these specialized studies, it may be
difficult to tell which type of IBD a young
person has. If this is the case, the diagnosis of
"indeterminate colitis" is made.
What is the Treatment?
Currently, there is no medical cure for IBD.
However, effective medical treatment is available
which can calm the inflammation, and relieve the
symptoms of diarrhea, abdominal pain, and rectal
bleeding.
The medical therapy for IBD in children and
adolescents is similar to the approach in adults.
Although it appears that medications are
generally safe and effective, they must be
closely monitored for side effects.
Some of the most common medications used to
treat IBD in children are 5-aminosalicylates
(5-ASA) and sulfasalazine. They can be given
orally or rectally and alter the body’s ability
to create and maintain inflammation. They ease
diarrhea, rectal bleeding, and abdominal pain.
Steroids, such as prednisone and prednisolone,
must be given very cautiously in this age group.
Steroids are powerful antinflammatories which can
ease moderate to severe IBD. These medications
are very effective, but have the significant side
effect of slowing linear (height) growth. Because
of side effects, many pediatric medication
strategies are designed to eliminate reliance on
prednisone. When steroids are necessary, they are
given for the shortest time possible in the
lowest effective dose.
Another group of drugs allow the majority of
young persons with IBD to markedly decrease or
eliminate the need for prednisone therapy. This
group is called the "immunomodulators".
Medications in this group include azlothioprine,
6-mercaptopurine (6-MP), and cyclosporine. They
alter the body’s immune cells from interacting
with the inflammatory process. As a result, they
relieve the symptoms of IBD.
Surgical treatment for children
In some pediatric patients, medical therapy is
not complete, or complications arise. Under these
circumstances, surgery may be considered.
Differing from Crohn’s disease, which can recur
after surgery, ulcerative colitis is
"cured" once the colon is removed.
For UC, newer surgical techniques have been
developed to remove the colon, maintain bowel
continuity and continence, and avoid a permanent
ileostomy. This technique involves creating an
internal pouch from the small bowel and attaching
it to the anal muscle. This allows the individual
to maintain bowel continuity and pass bowel
movements through the newly-constructed pouch. A
permanent stoma is avoided.
What resources are available to learn more
about IBD or support those with IBD?
An IBD support group meets bi-monthy at Penn
State Milton S. Hershey Medical Center. Persons
with IBD and their family members or support
persons are welcome. Please call (717) 531-6058
or (717) 531-8867 for more information.
Books: Inflammatory Bowel Disease: A guide
for Patients and Their Families (2nd ed.) by
Stanley H. Stein D.O. and Richard P. Rood M.D.
(1998)
The Ileal Pouch Anal Anastomosis: A Patient
Guide – available through Penn State Milton S.
Hershey Medical Center Dept. of General Surgery
– call (717) 531-5164
The Crohn’s and Colitis Foundation of
America (CCFA) has many pamphlets available –
call (800) 932-2423
Physician's Who Treat IBD
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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