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Inflammatory Bowel Disease |
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| Athos Bousvaros, MD, MPH |
The term Inflammatory Bowel Disease (IBD) primarily refers to two diseases, ulcerative colitis and Crohn's disease. Both are caused by the immune system reacting against the bowel, and are chronic (on-going) diseases consisting of active disease flare-ups and periods of disease remissions when the symptoms subside. A person who has either ulcerative colitis or Crohn's disease has IBD.
With ulcerative colitis, only the large intestine becomes irritated, sore and swollen, and the child or adult experiences cramping and bloody diarrhea. Because ulcerative colitis can come on suddenly, symptoms often are first believed to be caused by an infection. Cultures (stool studies) for bacteria done by a doctor can determine if there is an infection or if it may be ulcerative colitis.
With Crohn's disease, inflammation of any part of the gastrointestinal tract may occur and a child or adult may experience abdominal pain, diarrhea, rectal bleeding, fatigue, loss of appetite, weight loss, and anal infections. Crohn's disease can also come on suddenly, but often the onset and symptoms are more gradual and less specific than those of ulcerative colitis.
Along with the physical symptoms, Crohn's disease and ulcerative colitis can bring emotional stress. The inconvenience and frustration of irregular bowl habits can impact everyday life. There can also be long-term health effects including low bone density and iron deficiency, caused in part by altered digestion and the effects of medications.
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Inflammatory Bowel Disease (IBD) is different from irritable bowel syndrome (IBS). IBS is a very common disorder characterized by abdominal pain, constipation or diarrhea. It is often improved with dietary changes. The intestine is not inflamed in IBS and patients with IBS almost never have rectal bleeding.
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"The precise cause for these diseases is unknown," says Athos Bousvaros, MD, MPH, Associate Director of the Inflammatory Bowel Disease Program at Children's Hospital Boston. "However, family history increases a person's risk for getting these diseases. Environmental factors such as diet, intestinal bacteria, and smoking may also be important contributors to the development of these diseases."
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It is estimated that between 500,000 and one million people in the United States have either Crohn's disease or ulcerative colitis, and the incidences may be increasing. These diseases can occur at any age, but often begin in teenagers and young adults. About 10 percent of all people with IBD are under age 18, but it is rarely seen in children younger than 5 years old.
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IBD is suspected if a child or adult has had bloody diarrhea for more than two weeks, and especially if cultures (stool studies) done at the doctor's office do not show any signs of infection.
Other signs of Crohn's disease may include:
- Long-standing abdominal pains
- Unexplained fevers
- Joint swelling
- Poor growth
- Anal infections (perianal abscess)
Note: Abdominal pain in children is extremely common and is usually mild and not caused by Crohn's disease.
If a doctor suspects that a child has IBD, the doctor may recommend that the child undergo additional testing, including blood work, x-rays and colonoscopy. Together, these tests are usually effective in diagnosing IBD.
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"Both Crohn's disease and ulcerative colitis are very treatable and once the disease is diagnosed a physician can dramatically improve a child's health," Dr. Bousvaros says. The primary treatment is medical and the medications are similar for Crohn's and ulcerative colitis. Medications usually include prednisone, sulfasalazine, and 6-mercaptopurine, which help decrease the intestinal inflammation.
"This is a long-term illness, but in most patients, medication can lessen the abdominal pain, improve appetite, return stools to normal and make children feel healthy again," Dr. Bousvaros says. Steroids like prednisone are used for short periods to ease symptoms, but are not used over the long term because they can cause long- and short-term side effects. Steroid side effects may include facial swelling, weight gain, acne, delayed growth, high blood pressure, and weak bones.
In some cases, the disease does not respond to medications, so surgery may be necessary to improve a child's health. Two-thirds to three-quarters of all Crohn's disease patients may require surgery at some point in the course of their disease. Surgery may be performed to drain infections, remove obstructions, and remove diseased portions of the intestine.
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- See a doctor: If your child is exhibiting symptoms similar to those found in Crohn's disease and ulcerative colitis, consult your child's doctor. If the primary care physician thinks IBD is a possibility, he may refer your child to a pediatric gastroenterologist, a physician who specializes in the diagnosis and treatment of disorders of the gastrointestinal tract.
- Maintain good nutrition: Keep in mind that good nutrition is necessary for a child's healthy growth and development.
- Get support: Because these illnesses often come on during the teenage years when health and body image are important, they can cause additional stress during an already difficult period. Parents can ease this stressful time by being understanding and providing emotional support. Many children and teenagers benefit from individual counseling or from joining support groups. The Crohn's and Colitis Foundation of America provides educational information about IBD and sponsors regional support groups for children and adults.
- What research is being done?
Research on Crohn's and ulcerative colitis is on going and is focused on finding the specific genes that cause this disease as well as finding more effective and safe treatments.
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Source: Athos Bousvaros, MD, MPH, Associate Director of Inflammatory Bowel Disease Program at Children's Hospital Boston.
Please keep in mind that the text provided is for informational purposes only and is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to existing treatment.
Children's Hospital Boston©, 2005. This page may be reproduced for educational purposes. Reprint permission is required for all other uses.
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