Health Supervision in the Management of Children and Adolescents With IBD

Abstract

Ulcerative colitis (UC) and Crohn disease (CD), collectively referred to as inflammatory bowel disease (IBD), are chronic inflammatory disorders that can affect the gastrointestinal tract of children and adults. Like other autoimmune processes, the cause(s) of these disorders remain unknown but likely involves some interplay between genetic vulnerability and environmental factors. Children, in particular with UC or CD, can present to their primary care providers with similar symptoms, including abdominal pain, diarrhea, weight loss, and bloody stool. Although UC and CD are more predominant in adults, epidemiologic studies have demonstrated that a significant percentage of these patients were diagnosed during childhood. The chronic nature of the inflammatory process observed in these children and the waxing and waning nature of their clinical symptoms can be especially disruptive to their physical, social, and academic development. As such, physicians caring for children must consider these diseases when evaluating patients with compatible symptoms. Recent research efforts have made available a variety of more specific and effective pharmacologic agents and improved endoscopic and radiologic assessment tools to assist clinicians in the diagnosis and interval assessment of their patients with IBD; however, as the level of complexity of these interventions has increased, so too has the need for practitioners to become familiar with a wider array of treatments and the risks and benefits of particular diagnostic testing. Nonetheless, in most cases, and especially when frequent visits to subspecialty referral centers are not geographically feasible, primary care providers can be active participants in the management of their pediatric patients with IBD. The goal of this article is to educate and assist pediatricians and adult gastroenterology physicians caring for children with IBD, and in doing so, help to develop more collaborative care plans between primary care and subspecialty providers.

Health Care Maintenance for the Pediatric Patient With Inflammatory Bowel Disease

“…Patients with both UC and primary sclerosing cholangitis require annual-biannual colonoscopy with biopsies for colon cancer surveillance. 11 These patients are also at increased risk for the development of cholangiocarcinoma. 11…”

“…11 DXA Z scores < -2 indicate significant deficits in bone mass and body composition requiring further evaluation including bone age, measurement of serum calcium, phosphorus, magnesium, blood urea nitrogen, creatinine, parathyroid hormone, ionized calcium, tissue transglutaminase immunoglobulin (Ig) A, and vitamin D 25-OH levels. 2 Patients with z score < -1 require close monitoring with repeat DXA within 6 months.…”

Inflammatory Bowel Disease in Childhood and Adolescence

“…Endoscopic or histological re-evaluation is indicated before major changes to treatment and when response to treatment is uncertain (12). Colitis-associated cancers can occur in IBD patients even before the age of 18 years and necessitate appropriate screening (35,36).…”

Pediatric Ulcerative Colitis from Prevalence to Outcome

“…It mainly affects the mucosa and submucosa of the colon [8]. The aetiology of the disease is unclear and thought to be multifactorial [2,4,8]. Several factors may play a role in its development like genetic predisposition, environmental factors [2,4,8], immune dysregulation and bacterial flora [8].…”

“…Ulcerative Colitis (UC) is a chronic Inflammatory Bowel Diseases (IBD) [1][2][3][4][5][6] that is characterized by relapses and remissions [2][3][4][6][7][8]. It mainly affects the mucosa and submucosa of the colon [8].…”