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What is inflammatory bowel disease ?
Inflammatory
bowel disease is a term used to categorize two diseases which result primarily
in inflammation of the gastrointestinal tract: Crohn's disease and ulcerative
colitis. In Crohn's disease, the inflammation may involve either the small
intestine, the large intestine or both. The distribution of inflammation in
Crohn's disease can be scattered throughout the gastrointestinal tract as
ulcerations that extend deeper into the surface of the intestine.
Ulcerative colitis is an inflammatory disease of the gastrointestinal tract
that involves only the large intestine or colon. In ulcerative colitis, the
inflammation occurs as ulcers involving only the surface lining of the
intestinal.
How frequently is inflammatory bowel disease
diagnosed in children?
It is estimated that 2,000,000 Americans
suffer from inflammatory bowel disease. Of these patients 300,000 are children.
The majority of children diagnosed with inflammatory bowel disease are between
the ages of ten and twenty. Fewer than 5 percent of patient diagnosed with
inflammatory bowel disease are less than five years of age. Approximately one
fifth to one quarter of all patients with inflammatory bowel disease are
diagnosed before age twenty.
What are the common symptoms associated with
inflammatory bowel disease in children?
- diarrhea
- abdominal pain
- rectal bleeding
- fever
- weight loss
- poor growth
- delayed sexual maturation
What are the goals of medical treatment?
Drugs
cannot cure inflammatory bowel disease, but they are effective in reducing
inflammation and the accompanying symptoms. Goals of treatment for children and
adolescents with inflammatory bowel disease are to induce and then to maintain
remission, minimize medication side effects, promote growth, and to encourage
normal development, activity and participation.
How is inflammatory bowel disease treated?
There
is no single therapy that is universally effective in all patients with
inflammatory bowel disease. Treatment is individualized and modified depending
on the severity of the patients symptoms and by the area of the small or large
intestine affected. Treatment of inflammatory bowel disease includes a
combination of medications, nutritional therapy, surgery, attention to
psychosocial issues and education.
Why is nutrition important for those with IBD?
Children
with inflammatory bowel disease may suffer from malnutrition and growth failure.
This is thought to be the result of several different factors including poor
appetite, abdominal pain, impaired absorption and losses of dietary nutrients,
increased calorie requirements, and secondary to medication side effects.
Nutritional therapy is necessary to correct nutritional deficiencies, provide
adequate energy for healing of the inflamed intestine and to provide enough
calories for growth. Patient benefit from a balanced, high energy, high protein
diet. Some children may need supplemental nutritional support to provide 150
percent of the recommended daily dietary allowance. Low residue diets may be
recommended in patients with symptoms of abdominal pain or diarrhea. Patients
are often placed on supplemental vitamins, trace minerals and iron.
Nutritional therapy has also been used in children as a single form of
therapy. Liquid formulas are given to patients as their only form of nutrition.
This form of therapy has been shown to be effective in the treatment of children
with active inflammatory bowel disease and growth failure, avoiding medication
side effects and promoting growth.
What medications are prescribed for children with
inflammatory bowel disease?
- Anti-inflammatory medications corticosteroids -- intravenous, oral,
topical prednisone, prednisolone, hydrocortisone, methylprednisolone
sulfasalazine -- oral
- Azulfidine -- 5ASA + sulfapyridine
What newer medications are being used in the treatment of inflammatory bowel disease in children?
- Anti-inflammatory medications
- 5-ASA preparations -- oral, topical mesalamine- Asacol, Pentasa, Dipentum,
Rowasa coated or time release formulations
- New corticosteroid preparations -- oral, topical budesonide
- Immunosuppressive medications- oral, topical, intravenous, injection
- 6- mercaptopurine -- Purinethol
- Azathioprine -- Imuran
- Methotrexate -- Folex
- Cyclosporine -- Sandimmune
- Antimicrobial -- oral, intravenous
- Metronidazole -- Flagyl
- Ciprofloxacin -- Cipro
- Others
Antitumor Necrosis Factor -- Remicade-intravenous Anti-ICAM1 -- intravenous
Fish oil -- omega-3 fatty acids
When is surgery an option in children with inflammatory bowel disease?
Surgery
in patients with inflammatory bowel disease is performed to remove severally
diseased sections of either the small or the large intestine. Surgery is
curative in ulcerative colitis, and is recommended in patients with severe
colitis that is unresponsive to medical therapy. In patients with Crohn's
disease surgery is indicated in patients who do not respond to medications,
patients who develop significant complications secondary to their disease and in
children who fail to grow despite treatment. Approximately 50 to 70 percent of
children and adolescents with Crohn's disease require surgery within 10 to 15
years after their initial diagnosis is made.
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