Inflammatory bowel disease in children

Inflammatory bowel disease must be considered in the differential diagnosis of abdominal pain, weight loss, or rectal bleeding in children of any age. Colitis in the infant is more often caused by allergy to milk or soy protein but may be indistinguishable from ulcerative colitis and should be treated with hypoallergenic formulas such as Nutramigen or Pregestamil before other modes of therapy are initiated. Growth is of prime concern in children both at the onset and during therapy. Suppression of disease activity often requires steroids which are known to inhibit growth. The goals of management, therefore, aim for administration of steroids in doses and of a duration to control disease with no expectation for growth. Gradual tapering and elimination of steroids is usually followed by resumption or catch-up of linear growth. Short stature is more often associated with Crohn's disease than with ulcerative colitis, and although no metabolic abnormalities are identified, anorexia with hypocaloric intake is its usual cause. Surgical resection of the colon is curative of ulcerative colitis, and there should be no hesitation in recommending surgery for the patient who has severe growth failure or disease which has been unresponsive to therapy for 2 years. However, surgery is recommended cautiously in children with Crohn's disease because of a 50 to 75 per cent incidence of recurrence after operation. Furthermore, half or less of children with growth failure show no increase in growth after operation. Extracolonic manifestations of inflammatory bowel disease in children occur as in adults. The most significant are arthritis and erythema nodosum. Although considerable advances have been made in the physiology, diagnosis, and therapy of inflammatory bowel disease, there is as yet no medical cure available. The prognosis in children often carries prolonged periods of disability and in those with ulcerative colitis, a cancer risk increased over that of the adult.