Inflammatory Bowel
Disease
Dr. safia
The inflammatory bowel diseases (IBDs),
including ulcerative colitis and Crohn disease,
are chronic inflammatory disorders of the
gastrointestinal tract most often diagnosed in
adolescence and young adulthood, with a
rising incidence in pediatric populations.
These disorders are common enough in
children that most pediatricians and other
pediatric clinicians will encounter children
with IBD in their general practice.
Inflammatory bowel disease is caused by a
dysregulated mucosal immune response to
the intestinal microflora in genetically
predisposed hosts. Although children can
present with the classic symptoms of weight
loss, abdominal pain, and bloody diarrhea,
many present with nonclassic symptoms of
isolated poor growth, anemia, or other
extraintestinal manifestations.
Once IBD is diagnosed, the goals of therapy
consist of eliminating symptoms, normalizing
quality of life, restoring growth, and
preventing complications while minimizing
the adverse effects of medications.
Unique considerations when treating children
and adolescents with IBD include attention to
the effects of the disease on growth and
development, bone health, and psychosocial
functioning.
DISEASE CLASSIFICATION
Inflammatory bowel disease is classified into
Ulcerative Colitis and Crohn Disease .
Ulcerative colitis is characterized by diffuse,
continuous inflammation of the colon
extending from the rectum proximally.
Crohn disease can involve any area in the
gastrointestinal tract from the mouth to the
anus but most commonly involves the
terminal ileum and colon and can present
with an inflammatory, penetrating,
stricturing, or combination phenotype.
Endoscopic features that distinguish CD from
UC include discontinuous inflammation and
discrete aphthous or linear ulceration
In addition, 20% of children with CD will have
perianal involvement, including skin tags,
fissures, fistulas, and/or abscesses.
Clinical persentation
Pediatricians and other primary care clinicians
should become familiar with the atypical
presentations of IBD because 22% of children
present with growth failure, anemia, perianal
disease.
Treatment
Overall Treatment Goals and Strategy
The current goals of treatment are to
(1) eliminate symptoms and restore quality of
life
(2) restore normal growth
(3) eliminate complications.
Therapies for IBD may be broadly classified
according to their ability to induce remission
of active disease and maintain remission in
patients with quiescent disease. Some
therapies are effective only for remission
induction or maintenance, whereas others are
appropriate for both indications.
Corticosteroids
Corticosteroids are effective for the induction of
clinical remission in CD and UC in children;
Enteral Nutrition Therapy
Treatment with exclusive enteral nutrition (EEN),
defined as the provision of essentially 100% of
caloric needs by liquid formula
Anti-TNF Therapy
The introduction of therapeutic monoclonal
antibodies directed against TNF, a major
proinflammatory pathogenic cytokine in CD and
UC, has revolutionized the treatment of IBD.
These anti-TNF biologics are administered by
infusion (infliximab) or subcutaneous injection
Surgery
Surgery is an important therapeutic option in
the comprehensive management of UC and CD
in children. Total colectomy with ileal pouch
anal anastomosis is indicated in children with
UC refractory to medical therapy.
