Update in Pediatric Inflammatory Bowel Disease

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Key points

  • The number of children with inflammatory bowel disease (IBD) is on the increase.

  • Crohn disease and ulcerative colitis, the main subtypes of this intestinal inflammatory disease, affect both children and adults.

  • Children are developing physically, emotionally, and immunologically. The interface between this development and IBD affects presentation, diagnosis, and management.

  • This review focuses on the special aspects of pediatric IBD and how these influence management of children with IBD.

Pathogenesis

Although the cause is unclear, IBD is believed to result from an interaction of genetics, host immunity, and environmental factors. One of the most important risk factors for developing IBD is a positive family history of the disorder.7 Other possible factors include a child’s living conditions,8, 9 maternal smoking, and older maternal age during pregnancy.10 Controversial factors include the protective role of breast-feeding and whether certain vaccines, in particular measles vaccines, are

Diagnosis

Similar to adults, pediatric patients with IBD present most commonly with diarrhea and abdominal pain (Table 1). Rectal bleeding occurs more often in patients with ulcerative colitis, whereas patients with Crohn disease are more likely to have perianal disease. Weight loss is seen in most children with Crohn disease at the time of presentation. This malnutrition in these patients results from suboptimal dietary intake, increased gastrointestinal losses, malabsorption, and possibly increased

Treatment

The therapeutic goal in treating patients with IBD is mucosal healing and long-lasting remission. Treatment of pediatric patients with IBD should focus on the individual patient and requires a commonsense approach, with consideration of symptoms and quality of life, including growth, and minimizing side effects. There is a paucity of therapies approved specifically for children with IBD, therefore most of the treatment regimens are extrapolated from adult studies. Similar to adults with IBD,

Summary

The incidence of IBD in children is on the increase and approximately one-quarter of patients with IBD present in childhood. Pediatric patients with IBD can suffer both physically and psychosocially. An individualized therapeutic strategy in a child with IBD is necessary in terms of both medical and psychosocial management. Special attention should be paid to growth, immunizations, and mental health. IBD is a disorder with potential morbidities and lifelong challenges, therefore understanding

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      The underlying causes of IBD have not been fully identified; however, current theories acknowledge interactions between the intestinal gut microflora and the mucosa, especially in predisposed hosts, as responsible underlying mechanisms. Genetic factors seem to contribute only partially, while there is growing recognition that the microbial and environmental dimensions play an important role [2–4]. IBD manifests during childhood or adolescence in at least 20% of patients, often alternating between active and quiescent states.

    • Crohn's Disease and Gynecologic Manifestations in Young Women

      2016, Journal of Pediatric and Adolescent Gynecology
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      When Crohn's disease appears after puberty begins, menstrual irregularity or heavy bleeding might be the primary presenting gynecological complaint, as was seen in our series. Little is understood about specific reasons that Crohn's might result in delayed puberty; however, theories suggest that chronic inflammation results in decreased absorptive ability of the intestine, resulting in poor weight gain and poor nutrition.14–16 One patient in our series maintained a diagnosis of Crohn's, but there was concern that her presenting symptoms could have mimicked hidradenitis suppurativa.

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    Funded by: NIH, Grant number(s): 5K08DK089076; R21DK084554.

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