inflammatory bowel disease

Inflammatory bowel disease refers to a group of poorly understood conditions of chronic inflammation in the digestive tract, most often the small or large bowel (although these diseases can sometimes manifest themselves anywhere along the digestive tract or even outside of it in other organ systems such as skin, joints or eyes). By far the two most common diseases in this category are Crohn disease (sometimes referred to as transmural colitis) and ulcerative colitis.

These diseases may strike under a year, but in children more usually begin in the teens to early twenties. There is some increased risk (7-22%) of IBD in siblings, more in twins, and most in identical twins. Children who move to developed countries (as in international adoption) often appear to acquire the higher rates of IBD associated with the developed country. This has led to speculation that the presence of intestinal parasites may have some protective effect against these diseases.

A child with suspected inflammatory bowel disease would be naturally referred to a gastroenterologist, preferrably a pediatric specialist. At first, the differentiation between the two forms of IBD may be difficult. In about 10% of cases, it is never clear exactly which form of IBD is present, or only clear until some years after the initial diagnosis. Since the treatment of both forms is fairly similar, this is not the end of the world, so to speak, but accurate diagnosis is important for more refined treatment approaches. The diseases are ordinarily diagnosed by a combination of how the disease behaves clinically - what disease features and complications are present - as well as x-ray tests, the appearance of the bowel through the endoscope, and biopsy results obtained during direct endoscopic examination.

Comparison chart of Crohn Disease and Ulcerative Colitis
Feature Crohn disease Ulcerative colitis
Rectal bleeding Sometimes Common
Abdominal mass Common Not present
Rectal disease Occasional Nearly universal
Small bowel involvement Common None
Perianal disease Common Unusual
Strictures Common Unusual
Fistula Common Unusual
Discontinuous (skip) lesions Common Unusual
Transmural involvement Common Unusual
Granulomas Common Unusual
Risk for colonic cancer Slightly increased Greatly increased

Manifestations of IBD that occur outside of the gut itself (so-called extraintestinal manifestations) are common; they are slightly more common with Crohn disease than ulcerative colitis. There is a wide range of these complications; they may specifically affect the joints, skin, eyes, mouth, and the liver and gallbladder (hepatobiliary) system, as well as very rarely, the kidneys and lungs. Growth failure, a progressive relative dropoff in the height and weight percentiles on a child's growth chart, is often present by the time diagnosis is made, and may precede diagnosis by several years.

Extraintestinal manifestations of inflammatory bowel disease
Site Complication Description
skin pyoderma
rare, ulcerating sores most often on legs; usually with extensive and active colon disease
most common skin manifestation; more common with Crohn disease; may raise suspicion of IBD in previously healthy child
mouth recurrent
most common skin manifestation; more common with Crohn disease
  other assorted
mouth lesions
lip swelling, fissures, gum inflammation (gingivitis)
joints migratory
involves the large joints; redness, swelling and stiffness; generally non-destructive (as opposed to rheumatoid arthritis); parallels bowel disease
  ankylosing spondylitis inflammation of the vertebrae; usually begins in the early twenties, most commonly with ulcerative colitis who have a certain human leukocyte antigen (B27); low back pain and morning stiffness; back, hips, shoulders, and sacroiliac joints typically affected
eye episcleritis fiery red inflammation of the conjunctivae mimicing "pink eye" eyes red, burn; vision not affected
inflammation of the iris and accomodative muscle (ciliary body); eye pain, headache, blurred vision; possible glaucoma, cataracts, and permanent visual impairment; may initially be silent
liver primary
chronic inflammation and obliteration of the bile ducts within and outside of the liver; cirrhosis; nonspecific fatigue, appetite loss, itching, and jaundice
bone osteoporosis mild bone loss affects 2/3 of IBD patients; increased risk of fractures, bone deformities, chronic pain
blood anemia nutritional: deficiencies of iron, B12, folate; the "anemia of chronic disease"
kidney rare glomerulonephritis: deposition of immune antigen/antibody complexes in the filtering tubules; amyloidosis; kidney stones
blood clots in extremities, or brain (stroke)
  arteritis inflammation of blood vessels in extremities, or brain (stroke)

Resources for patients with inflammatory bowel disease on the web abound.

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