Understanding Pediatric Inflammatory Bowel Disease

There are so many acronyms in the world of medicine. It can be confusing how pediatric IBD differs from the similarly named IBS (irritable bowel syndrome).

While IBS and IBD often have overlapping symptoms, they are two distinct disorders. IBS is considered a “functional” disorder, meaning that though it can seriously interfere with quality of life, it rarely requires hospitalization or surgery.

On the other hand, IBD is classified as an autoimmune disease in children and adults. It can be clearly identified via diagnostic imaging. IBD can cause inflammation and even permanent damage to the intestines.

IBD may require surgical treatment. It may also become progressively worse over time if left untreated.

IBD typically presents in two forms: ulcerative colitis or Crohn’s disease. These conditions cause many of the same symptoms but have key differences as well.

Pediatric ulcerative colitis

Ulcerative colitis attacks only the large intestine — the lower portion of the gastrointestinal (GI) tract that absorbs water and nutrients, and prepares waste for exiting the body.

Ulcerative colitis doesn’t affect the large intestine in a piecemeal fashion. Instead, it causes continuous, uniform inflammation throughout this part of the body.

Pediatric Crohn’s disease

Whereas ulcerative colitis affects only the large intestine, Crohn’s disease can cause inflammation anywhere in the GI tract, all the way from the mouth to the rectum.

Unlike ulcerative colitis, some portions of the digestive system are unaffected, with healthy tissue mixed in between inflamed areas.

Symptoms of ulcerative colitis and Crohn’s disease in children may include:

• abdominal pain and cramping (may be more pronounced on the left side)
• episodes of bloody diarrhea
• anal fissures (more common in Crohn’s disease)
• rectal bleeding
• weight loss
• loss of appetite
• fatigue
• joint pain or stiffness
• skin sores or canker-like sores
• fever
• delayed growth from lack of nutrition

While it would be nice to point to a specific cause for your child’s symptoms, science has yet to nail down why some children develop IBD and others do not.

“The simple answer is we do not yet know what exactly causes inflammatory bowel disease, although we believe it is an interaction between the body’s immune system, genetics, the environment, and microorganisms in the gut,” says Ashish S. Patel, MD, division chief of gastroenterology and hepatology at Phoenix Children’s Hospital.

However, there’s hope that teasing apart the cause of pediatric IBD is only a matter of time.

“There is a tremendous amount of research underway focused on the why,” Patel says.

Although specific causes of pediatric IBD may be unknown, certain risk factors do seem to make a difference to a child’s likelihood of developing the disease.

“The primary risk factors we know in children are genetic, so there is an increased risk for children who have a first-degree relative with IBD,” says Patel.

In fact, research shows that 15% to 30% of people with IBD have a relative with either Crohn’s disease or ulcerative colitis.

Other factors may also increase risk.

“In general, we know that there is a higher rate of disease in developed countries, which may speak to environmental influence. Historically, we saw IBD in certain ethnicities; however, the disease itself does not discriminate based on race, sex, or age,” Patel says.

In everyday life, ulcerative colitis and Crohn’s disease may look like nearly the same disease. For this reason, your pediatrician or specialist will likely need to conduct diagnostic testing to determine which of the two your child has.

After going through a thorough check of your child’s symptoms and family history, a doctor may order the following tests:

• blood tests, including complete blood count (CBC) and erythrocyte sedimentation rate (ESR)
• stool culture
• endoscopy
• upper GI series or barium swallow
• lower GI series or barium enema
• urinalysis
• biopsy of the colon

If your child is diagnosed with ulcerative colitis or Crohn’s disease, you’re not without treatment options.

“These are considered autoimmune conditions, so the cornerstone of medical management is suppression of inflammation,” says Patel.

In this case, suppressing the immune system usually involves administering prescription drugs (often steroids), which come in oral, injectable, or intravenous forms.

Anti-spasmodic or antidiarrheal medications may also be a part of your child’s treatment.

Dietary adjustments may help manage some symptoms too. Working with a dietitian or GI specialist can help identify foods that trigger or worsen IBD flares. A doctor may also recommend dietary supplements to fill in nutrient losses from excessive diarrhea.

Children can outgrow some childhood conditions, but pediatric IBD is a chronic condition.

“Although there have been significant advancements in medical therapeutics for pediatric IBD in the last two decades, there is still no cure for IBD,” says Patel.

However, he points out that this condition has very good treatments.

“It is not likely to worsen over time unless it is not effectively controlled and proactively monitored. If proper treatment is started and remission is achieved, this significantly decreases the long-term problems that can be associated with uncontrolled disease, like colon cancer, surgical interventions, fertility issues, and hospitalizations,” Patel says.

A diagnosis of IBD in your child can be a lot to process at first. Getting your child the proper treatment as soon as possible will set them on a path toward disease management that will improve their quality of life in the long term.

At what age is IBD diagnosed?

IBD is typically diagnosed in adulthood, but cases in children are on the rise.

“Children account for about 25% of new cases of IBD diagnosed each year,” says Patel. “We are now seeing this earlier and earlier into childhood as well. In some rare cases, IBD is diagnosed in the first year of life.”

Is pediatric IBD more common in boys or girls?

Research shows that boys are slightly more likely to develop Crohn’s disease in childhood than girls.

Ulcerative colitis, on the other hand, appears to affect both boys and girls equally.

Is pediatric ulcerative colitis or Crohn’s disease more common?

In the preschool age group, ulcerative colitis is more common than Crohn’s disease, but in older children, Crohn’s is three times more common than ulcerative colitis, according to 2012 research.