Ulcerative Colitis in Children

Abstract

Ulcerative colitis is a chronic relapsing inflammatory disorder of the colonic mucosa of unknown etiology. The inflammatory process involves the mucosa and submucosa in a continuous segment of bowel with rectal involvement in almost all cases. Since its etiology is unknown, therapy is directed at modulating the inflammatory response in order to control symptoms and to prevent relapses. 5-aminosalicylates and corticosteroids have been the most widely used therapeutic agents for treatment of ulcerative colitis. Recently, experience has been gained with the use of other immunomodulators, such as mercaptopurine, azathioprine, methotrexate, cyclosporine, and tacrolimus, in pediatric patients. Colectomy is indicated in patients with severe colitis who do not respond to intensive medical therapy. The care of children with ulcerative colitis not only involves control of symptoms from gastrointestinal and extraintestinal manifestations, but also optimizing growth and development. The complications of chronic inflammation and long-term medical therapy must be weighed against the risks and benefits of surgery for children and adolescents with this condition.

Synbiotic Therapy: A Promising New Adjunctive Therapy for Ulcerative Colitis

“…3,4 The current hypothesis is that IBD is "an inappropriate response to either the endogenous microbial flora within the intestine, with or without some component of autoimmunity." 1 Research suggests that IBD may also have an infectious etiology.…”

“…7 Although unusual, patients with UC may also present with extraintestinal manifestations including liver disease, arthritis and skin lesions. 4,8 The peak age of onset in the adult population is usually during either the second and third or the fifth and sixth decades of life. 2 Age of onset of UC in pediatric patients is in late adolescence.…”

“…4 Initial investigations in a patient with symptoms of UC are to exclude enteric infection with stool examinations for bacterial and viral pathogens (i.e., salmonella, shigella, campylobacter, aeromonas, plesiomonas, yersinia, E. coli 0157:H7, Clostridium difficile, or Entamoeba histolytica). 4,8 Routine investigations include complete blood count, albumin, iron status, and measurement of inflammatory markers such as C-reactive protein and the erythrocyte sedimentation rate. 8 Endoscopy is indicated in all cases for diagnosis and to assess disease extent.…”

“…8 Endoscopy is indicated in all cases for diagnosis and to assess disease extent. 4,8 Histology is required to confirm the diagnosis and to distinguish UC from Crohn's disease. 8…”

“…8,9 In addition to pharmacological therapy, "the consequences of UC on peer and family relationships, school attendance, and emotional well-being should be included as part of the comprehensive management of this disorder." 4 Since the etiology of UC is unknown, the goals of medical therapy in pediatric UC patients are to control symptoms, prevent relapses, maintain growth, and promote pubertal development. 4,9 The treatment approaches for children with UC are based on experience in adults.…”