Other Conditions

Overview
Symptoms
Treatment options
Surgeries
Support and links

Overview
Symptoms
Treatment options
Surgeries
Support and links

Understanding pediatric Crohn's disease

Overview

Crohn's disease (CD) is one of two common types of inflammatory bowel diseases (IBD) that affect approximately 1.4 million Americans. It is estimated that about 140,000 children suffer from Crohn's disease and a related illness, ulcerative colitis (UC). In fact, some 25% of IBD patients develop these diseases as children or teenagers.

Crohn's disease causes the inner surface of the intestine to become raw, eroded, and inflamed. The chronic illness can affect any part of a child's gastrointestinal (GI) tract, from the mouth to the rectum, and even the skin outside the anal opening. However, the areas most often affected are the lower part of the small intestine (ileum) and the large intestine (colon).

While the cause of Crohn's disease is not yet known, researchers believe that it takes a number of circumstances working together to bring about Crohn's disease, including the following:

Genetics
Abnormal immune response
Something in the environment

When Crohn's disease is diagnosed before puberty, children may experience delayed or stunted growth. Signs of growth failure include a lower-than-expected increase in height and weight. Other signs of growth failure are delayed bone development (which can be measured by X-ray) and an onset of puberty that appears delayed compared with the family pattern.

Children with Crohn's disease may be aware that they are shorter than most of their classmates, and parents may notice that the size of a child's clothing and shoes remains the same for a long period of time.

Symptoms

Symptoms of Crohn's disease in both adults and children may include:

Persistent diarrhea
Abdominal pain
Rectal bleeding
Fever
Weight loss

Symptoms may appear gradually or develop very suddenly. Abdominal pain and diarrhea are often the earliest signs, while lack of appetite, weight loss, and slowed growth are also common. In fact, in some children, nonspecific weight loss or slowed growth may be the initial symptoms of the disease. Other signs of Crohn's disease include sores in the anal area, extra folds of skin around the anal opening, and anal fistulas (tiny openings or pores from which pus-like fluid can seep).

Treatment options

Treatment options for pediatric Crohn's disease are similar to those for adult Crohn's disease since the therapeutic goals remain the same. Physicians may opt for drug therapies, such as corticosteroids.

The proper medication regimen is important in controlling your child's Crohn's disease. It is important that you help your child's doctor determine the best combination for your child. However, keep in mind that nearly all medications have side effects. Be sure to check the patient information provided with the prescription and talk to your child's doctor about the kinds of side effects certain medications may have, and whether they are safe for your child to use.

Physicians may also attempt to manage pediatric Crohn's symptoms with manipulation of diet or, as in adult Crohn's, with surgery.

A physician will determine the appropriate treatment for a child based on the child's age, overall health, and medical history. He or she will also assess the extent of the disease, as well as the child's tolerance for specific medications or procedures. Parents should thoroughly discuss with their child's physician the most beneficial and appropriate course of treatment.

Five different categories of drugs are used in IBD:

Aminosalicylates (5-ASA-based drugs)

When someone is first diagnosed with Crohn's disease, he or she may be treated initially with drugs containing mesalamine, which helps control inflammation. Sulfasalazine is the most commonly used of these drugs. If you do not benefit from sulfasalazine or cannot tolerate it, you may be put on other drugs that contain mesalamine, generally known as 5-ASA agents. These drugs are frequently effective for mild-to-moderate, but not severe, inflammation.

Antibiotics

Antibiotics are used to treat bacterial overgrowth in the small intestine caused by strictures, fistulas, or prior surgery. They are also used to treat any bacterial infections that are present, including abscesses. Your gastroenterologist may prescribe an antibiotic therapy.

Biologics

Biologic therapy has also been studied in pediatric Crohn's patients. These drugs specifically target parts of the immune system that lead to inflammation associated with Crohn's disease. By quickly relieving inflammation and helping to control symptoms, biologic therapy may reduce or eliminate the need for steroids.

Corticosteroids

Corticosteroids help control inflammation and are very effective for active Crohn's disease, even if severe. If you respond to steroid treatment, your gastroenterologist will usually try to gradually lower the dose of the steroid in order to avoid some of the significant side effects of this class of drugs. Corticosteroids are not recommended for long-term therapy.

Immunomodulators

Drugs that modulate or alter the immune system are also used to treat Crohn's disease. Most commonly prescribed are 6-mercaptopurine (6-MP) and a related drug, azathioprine. Immunomodulators work by blocking the immune reaction that contributes to inflammation. It often takes a few months of treatment for immunomodulators to take effect.

Surgeries

Surgery may be necessary for children with Crohn's disease when medication no longer controls their symptoms. It also may be called for when there is an intestinal obstruction or other complication that cannot be managed by medication. In most cases, an irreversibly diseased segment of bowel is removed, and the two ends of healthy bowel are joined together. This is called resection and anastomosis. While this surgery may allow for many symptom-free years, it is not considered a cure, as the disease may recur at or near the site of anastomosis.

Support and links

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Understanding ulcerative colitis

Overview

Ulcerative colitis (UC) is a chronic, inflammatory disease of the colon that causes ulceration of the colon's lining. Ulcerative colitis affects approximately 500,000 people in the U.S. UC symptoms can begin at any age, but the disease is usually diagnosed between the ages of 15 and 30.

UC is categorized by the location of inflammation in the colon.

Ulcerative proctitis, the most common type of UC, is a disease that is confined to the rectum
Distal, or limited colitis, refers to inflammation that affects only the left side of the colon
Pancolitis refers to UC that affects the entire colon

Doctors are unsure of what causes UC, however, many believe that it is a combination of a person's genes and how the immune system in the intestine reacts to an environmental or infectious agent.

UC Versus Crohn's

Symptoms

The most common ulcerative colitis symptoms are:

Diarrhea
Rectal bleeding
Urgency to have a bowel movement
A feeling that you still need to have a bowel movement after having one (tenesmus)
Passage of mucus
Crampy abdominal pain

You may also experience fatigue, weight loss, loss of appetite, and loss of body fluids and nutrients.

Half of the people with ulcerative colitis experience mild symptoms. Others experience more severe symptoms, such as frequent fever, bloody diarrhea, nausea, and severe abdominal cramps.

Ulcerative colitis symptoms often come and go. The period of time between flare-ups is called remission. Remission can last several months or even years.

UC may be associated with several complications, such as:

Arthritis
Inflammation of the eye (iritis)
Osteoporosis
Skin rashes

Scientists believe these complications develop when the inflammation that affects the colon triggers inflammation in other parts of the body.

Treatment options

Treatment for UC is designed to induce and maintain remission. Physicians choose a treatment based on the severity and location of the disease.

The proper medication regimen is important in controlling your UC. It is important that you help your doctor determine the best combination for you. However, keep in mind that nearly all medications have side effects. Be sure to check the patient information provided with your prescription and talk to your doctor about the kinds of side effects certain medications may have, and whether they are safe for you to use.

Several categories of therapies include the following:

Antidiarrheal medications

Patients who have mild diarrhea may be prescribed antidiarrheal drugs. Your doctor may prescribe several antidiarrheal agents, including loperamide. In severe cases, your gastroenterologist will closely monitor you if you are taking these antidiarrheal drugs to avoid triggering toxic megacolon, a serious complication. If you are dehydrated because of diarrhea, you will be treated with fluids and electrolytes.

Anti-inflammatory agents

The most common anti-inflammatory drugs used to treat ulcerative colitis are aminosalicylates, which are aspirin-like drugs that contain 5-aminosalicylic acid (5-ASA). These drugs can be taken orally or rectally, through an enema, or in a suppository. How you take the medication will depend on the location of the inflammation in the colon. Most people with mild or moderate UC are treated with this group of drugs first. Your gastroenterologist may prescribe one or more of the following 5-ASA drugs: mesalamine, sulfasalazine, olsalazine, and balsalazide.

Biologics

Biologics are the latest form of therapy for the treatment of UC. These drugs selectively target parts of the immune system that lead to inflammation associated with UC.

Corticosteroids

Corticosteroids, such as prednisone, methylprednisolone, and budesonide, have been used for many years to reduce inflammation in patients who have not responded well to 5-ASA medications, or who have moderate to severe ulcerative colitis. Corticosteroids can be given orally, intravenously, through an enema, or in a suppository, depending on the location of the inflammation. Patients often see an improvement in their symptoms within days after starting steroids. While steroids are effective in the short-term control of a flare-up, it is not recommended that they be used for a long time because of side effects.

Immunomodulators

Drugs such as azathioprine and 6-mercaptopurine, or 6-MP, have been used to maintain remission of ulcerative colitis and decrease the need for steroids. However, this class of drugs may take up to three to six months to produce maximal effect. Cyclosporine has been given to some people who suffer severe flare-ups and have not responded to corticosteroid therapy. It often takes a few months of treatment for immunomodulators to take effect.

Surgeries

The risk of surgery increases with the duration and extent of disease. Many people with ulcerative colitis (UC) may never require surgery. Currently, there is no medicinal cure for ulcerative colitis, and 25% to 40% of ulcerative colitis patients will eventually have their colons removed because of severe illness, risk of cancer, massive bleeding, or rupture of the colon.

If you do have to undergo surgery, you may have one of two common procedures.

Ileostomy
During an ileostomy, the surgeon creates a small opening in the abdomen, called a stoma, and attaches the end of the small intestine, called the ileum, to it. The stoma is about the size of a quarter and is covered by a pouch. Waste travels through the small intestine and exits the body through the stoma and into the pouch. The patient empties the pouch as needed.

Ileoanal anastomosis
Ileoanal anastomosis is a fairly new procedure that allows the patient to have normal bowel movements because it preserves the anus. The colon is still removed, but the doctor creates an internal pouch from the small bowel and attaches it to the anal sphincter muscle. Waste is stored in the pouch and is passed through the anus in the usual manner.

Other Conditions

Understanding pediatric Crohn's disease

Overview

Symptoms

Treatment options

Aminosalicylates (5-ASA-based drugs)

Antibiotics

Biologics

Corticosteroids

Immunomodulators

Surgeries

Support and links

LivingwithCrohn'sDisease

Crohn's & Colitis Foundation of America

HealingWell.com — Crohn's Disease Resource Center

Johns Hopkins — Gastroenterology and Hepatology Resource Center

American College of Gastroenterology

American Gastroenterological Association

National Institutes of Health

Johns Hopkins Medicine

Mayo Clinic

Understanding ulcerative colitis

Overview

Symptoms

Treatment options

Antidiarrheal medications

Anti-inflammatory agents

Biologics

Corticosteroids

Immunomodulators

Surgeries

Support and links

LivingWithUC

Crohn's & Colitis Foundation of America (CCFA)

Johns Hopkins Gastroenterology and Hepatology Resource Center

American College of Gastroenterology (ACG)

American Gastroenterological Association (AGA)