Inflammatory Bowel Disease in Children and Adolescents

Abstract

The inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn disease, are chronic inflammatory disorders of the gastrointestinal tract most often diagnosed in adolescence and young adulthood, with a rising incidence in pediatric populations. These disorders are common enough in children that most pediatricians and other pediatric clinicians will encounter children with IBD in their general practice. Inflammatory bowel disease is caused by a dysregulated mucosal immune response to the intestinal microflora in genetically predisposed hosts. Although children can present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhea, many present with nonclassic symptoms of isolated poor growth, anemia, or other extraintestinal manifestations. Once IBD is diagnosed, the goals of therapy consist of eliminating symptoms, normalizing quality of life, restoring growth, and preventing complications while minimizing the adverse effects of medications. Unique considerations when treating children and adolescents with IBD include attention to the effects of the disease on growth and development, bone health, and psychosocial functioning. The purpose of this review is to provide a contemporary overview of the epidemiologic features, pathogenesis, diagnosis, and management of IBD in children and adolescents.

Figure. Representative Endoscopic Images of Normal and Inflamed Gastrointestinal Mucosa From Pediatric Patients With and Without Inflammatory Bowel Disease

A, A vascular pattern, villous epithelium, and normal lymphoid nodularity are visible. B, A thin transparent glistening mucosa and delicate vascular network are visible. C, Terminal ileum in a child with Crohn disease (CD) shows mucosal thickening and erythema, complete loss of vascular pattern, pseudopolyps surrounded by deep ulceration, and luminal narrowing. D, Linear ulcer directly adjacent to normal colon mucosa in a young child with CD. E, Tissue in the stomach antrum of a 10-year-old child with CD. F, An adolescent with ulcerative colitis has diffuse erythema, loss of vascular pattern, and granular-appearing superficial ulceration.