There are two types of chronic inflammatory bowel disease (IBD) in children, ulcerative colitis and Crohn disease. These are two different conditions that both cause inflammation in the intestines. It is not known what causes either type of IBD, but it does seem to run in certain families, with a 7-22% risk of having IBD if someone else in the family also has it. The peak age of onset of IBD is adolescence and young adulthood (15-25 years).
The most common symptoms of ulcerative colitis and Crohn disease are diarrhea, usually with bleeding, cramping abdominal pain, obstruction (a blockage of the intestine), malabsorption (failure of the intestines to absorb minerals and nutrients), and weight loss or poor weight gain. Other symptoms can include fever, anorexia (poor appetite), anemia (low blood counts), skin rashes, especially erythema nodosum (tender red bumps or nodules on the front of the lower legs) and pyoderma gangrenosum (painful skin ulcers), oral aphthous ulcers, and hepatitis (inflammation of the liver). Children with Crohn disease can also have perirectal disease, with fistulas, abscesses, or fissures around the rectum.
Diagnosis of IBD includes excluding other illness that can cause similar symptoms, including gastrointestinal infections, and so stool cultures will usually be performed. Other testing may include blood counts, urinalysis, sedimentation rate (ESR), chemistry tests, an upper GI and/or barium enema. Testing will also include a colonoscopy so that biopsies can be done to confirm the diagnosis.
There is no medical cure for IBD. Treatments of ulcerative colitis and Crohn disease are aimed at controlling inflammation and include the use of steroids, such as prednisone when the illness flares up, with a gradual tapering of the dose once symptoms improve. Other treatments include regular use of aminosalicylates (which are taken with Folic acid), such as sulfasalazine, olsalazine and mesalamine. Antibiotics are also commonly used, including Metronidazole and Ciprofloxacin in older adolescents. Children with severe cases may also be treated with immunosuppresive drugs, such as 6-mercaptopurine, azathioprine, or cyclosporine A. Surgery is sometimes also considered for severe cases, which can cure ulcerative colitis and treat complications in children with Crohn disease.
Another important part of the treatments for both ulcerative colitis and Crohn disease is proper nutrition. This can help to provide enough calories for proper growth and development, and replace vitamin and mineral deficiencies (including folate, B12, iron, zinc, calcium, magnesium, and Vitamins A, D, E, and K) that can commonly occur in children with IBD.
Children may also need psychological support from a counselor, psychologist and/or support group.
Management will also include frequent colonoscopies after 8-10 years of having IBD because there is an increased risk of colon cancer, especially in patients with ulcerative colitis, and early detection and help with the prevention of colon cancer developing.
IBD is a chronic condition and most children with this disorder will have frequent remissions, during which they may be symptom free and relapses, when symptoms return.
Treatment of IBD in children should usually be performed by a pediatric gastroenterologist and nutritionist, in addition to a pediatrician for primary care.
Inflammatory Bowel Disease Internet Resources:
- Crohn's & Colitis Foundation of America: "CCFA's mission is to cure and prevent Crohn's disease and ulcerative colitis through research, and to improve the quality of life of children and adults affected by these digestive diseases through education and support." Check their medical central library for information and basic facts about IBD, including tests, medications, surgery, diet, nutrition and coping day to day.
- Clinical Trials for Inflammatory Bowel Diseases: - "ClinicalTrials.gov - Linking Patients to Medical Research about Inflammatory Bowel Diseases
- Inflammatory Bowel Disease in Children: - IBD refers to two diseases that cause intestinal inflammation. Although ulcerative colitis and Crohn's disease share some features, there are important distinctions. What are they and how should you care for your child?"
- How is IBD diagnosed?: information about how Crohn's disease and Ulcerative Colitis may be diagnosed, including Blood Tests, X-rays: "Upper GI" and "Small Bowel Series", X-rays: "Lower GI" (Barium Enema), Colonoscopy or a Limited Flexible Sigmoidoscopy with Biopsies, Upper Endoscopy with Biopsies, and Biopsy.
- Inflammatory Bowel Disease: "AMERICAN GASTROENTEROLOGICAL ASSOCIATION AND THE AMERICAN DIGESTIVE HEALTH FOUNDATION includes information for physicians and the public about digestive disease symptoms, treatments, research initiatives, continuing medical education, practice management, medical position statements and public policy information.