Inflammatory Bowel Disease in Children and Adolescents

What Is Inflammatory Bowel Disease?

Inflammatory Bowel Disease (IBD) is a chronic condition common in children. It has been estimated that almost 25% of all the cases of IBD occur in children. Two types of IBD are Ulcerative colitis and Crohn's disease. Both types of IBD have specific characteristics and have different treatment regimens. However, when the clinical features fail to distinguish between the two types, the condition is termed as indeterminate colitis. IBD is characterized by inflammation and swelling in the lower part of the gastrointestinal tract i.e. the colon and rectum. Pediatric IBD is a complex condition and the incidence of IBD in the pediatric population is on the rise. Extraintestinal symptoms of IBD occur in approximately 25-35% of the patients. However, in children, the extraintestinal symptoms may occur much before the gastrointestinal symptoms while in adults these symptoms occur simultaneously with gastrointestinal symptoms.

What Is the Pediatric Inflammatory Bowel Disease Program?

Pediatric inflammatory bowel disease program is a specialized program for children suffering from IBD. The program offers comprehensive diagnosis and management of IBD including ulcerative colitis and Crohn’s disease along with other intestinal disorders. Hospitals with large infrastructure have a multidisciplinary approach and a team of specialists including gastroenterologists, urologists, paediatricians, and nutritionists provides excellent care to the patients. Along with medications and surgical interventions, diet care, stress management, and lifestyle changes are also advised under the Pediatric inflammatory bowel disease program. 

What Are the Symptoms of Inflammatory Bowel Disease?

The symptoms of IBD depend upon the type developed in children. 

General symptoms of IBD are:

  • Abdominal Pain

  • Weight loss

  • Fever

  • Delayed growth

  • Diarrhoea

  • Fatigue

  • Blood in stools

  • Reduces appetite

  • Iron deficiency anaemia because of blood loss

  • The urgency for a bowel movement

  • Inflammation in skin, joints, and eyes

What Are the Risk Factors for Inflammatory Bowel Disease?

Factors that exacerbate or increases the risk of developing IBD are:

Family History: The risk of developing IBD increases when the close relative of the person such as parents or child suffers from IBD. 

Age: Generally, IBD is diagnosed in people under the age of 30 years. However, it may also be diagnosed after 50 years.

Ethnicity: White people have a high risk of developing this condition. 

Smoking: People who smoke are at increased risk of developing and exacerbating IBD.

Habitat: Environmental factors such as smoke or pollution also increases the risk of IBD. 

Prolonged use of Anti-inflammatory medications: NSAIDs drugs increase the risk of developing IBD and worsens the symptoms of this condition. 

What Are the Types of Inflammatory Bowel Disease?

The two types of IBD are Crohn’s disease and Ulcerative colitis. It is important to diagnose the type of IBD because both have different medical intervention strategies.

Characteristics Crohn’s Disease Ulcerative Colitis
Affected site May affect any part of GIT Affects colon in most cases
Abdominal Pain Common Unusual
Distribution Discontinuous Continuous
Fever and malaise Common Uncommon
Colon cancer risk Slightly increased Significantly increased

 

How is the Diagnosis of Inflammatory Bowel Disease Done?

The diagnosis of the IBD is done through the following diagnostic techniques:

Physical Examination: Comprehensive physical evaluation is done by the pediatric gastroenterologists in patients who are presented with the symptoms of IBD such as abdominal pain, fever, and diarrhea. The doctor may advise further tests to confirm the diagnosis of IBD. 

Blood tests: Blood tests help in providing important clues related to inflammatory bowel disease. Anaemia and the presence of infection are determined through blood tests.

Stool test: The stool test is done to identify the presence of blood in stools.  

Endoscopic procedures: Various endoscopic procedures are done to determine the presence, extent, and severity of the disease. Various endoscopic procedures done are colonoscopy, upper endoscopy, flexible sigmoidoscopy, balloon-assisted endoscopy, and capsule endoscopy.  

Imaging tests: Imaging tests such as X-ray, MRI, and CT scans are also performed to diagnose IBD. 

What Are the Treatment Options for Inflammatory Bowel Disease?

The treatment for IBD depends upon the type of condition, i.e. whether ulcerative colitis or Crohn's disease. The treatment aims to prolong the period of remission and prevent the occurrence of inflammation and pain. Following are some of the treatment options for IBD:

Medications: Various medications are prescribed for IBD. Corticosteroids and other anti-inflammatory drugs are administered for reducing inflammation. Immunosuppressants are prescribed to keep the immune system under check. Other medications include antibiotics, pain relievers, and vitamins, and mineral supplements. 

Nutrition: Nutritional support is provided to the patient suffering from IBD. This may include specialized diet protocols such as Crohn's Disease Exclusion Diet (CDED) and Exclusive Enteral Nutrition (EEN), which does not irritate the GIT and enteral tube feeding or parenteral nutrition. 

Surgery: As ulcerative colitis is generally specific to the colon, removing the colon and rectum (proctocolectomy) may cure this condition.  However, Crohn’s disease, although requiring surgery, cannot be cured. The surgery in Crohn’s disease only offers temporary relief.

 

Dr. Srikanth K P

Consultant - Paediatric Gastroenterology and Hepatology

Manipal Hospitals Bangalore – Old Airport Road

 

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