Paediatric Inflammatory Bowel Disease

Paediatric inflammatory bowel disease (PIBD) includes Crohn’s disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU)^1,4.
This medical condition occurs during early childhood (before 16-18 years)¹.

PIBD is a chronic, relapsing and remitting inflammatory condition characterised by intestinal inflammation leading to abdominal pain, diarrhoea, bloody stools and other intestinal and extra-intestinal symptoms and complications¹.

Paediatric CD can affect any portion of the digestive tract from the mouth to the anus. However, it most commonly involves the terminal part of the small intestine (ileum) and the large intestine (colon)^2,3.

In Paediatric UC, the inflammation is often limited to the colon, starting from the rectum^3,4,5.

The most common clinical features of Crohn’s disease in children are¹:

• Abdominal pain (>85%)
• Diarrhoea (>75%)
• Weight loss (>55%)

The most common clinical features of Ulcerative colitis in children are¹:

• Abdominal pain (>85%)
• Bleeding per rectum (>90%)
• Diarrhoea (>90%)

Some affected children may also feel tired, experience fever or loss of appetite. Growth retardation is common at the time of diagnosis, especially in paediatric CD^2,5.

IBD in children also presents with extraintestinal manifestations, which include^2,5:

The specific cause of paediatric IBD is not fully understood. The disease most likely occurs due to a combination of genetic, immunologic and environmental factors^1,2

Genetic predisposition

• Alterations of several different genes play a role in the disease^2,3
• Many of the genes associated to paediatric IBD are involved with the function of the immune system^2,4,5
• Between 15% to 25% of children with IBD have an affected relative^1,2,3

Environmental factors

• Bacterial or viral infections²
• Frequent antibiotic use²
• Westernised diet²
• Smoking²
• Imbalanced gut microbiota²

Paediatric IBD occurs when, in genetically predisposed individuals, the immune system responds to a trigger in an abnormal way. The immune system does not shut off appropriately and mistakenly attacks the small and large intestines leading to chronic inflammation.

Doctors can do the following tests^2,3,5:
Blood tests To check for anaemia (low level of red blood cells) and inflammation (high level of white blood cells)².

Colonoscopy Doctors put a thin tube with a camera into the rectum to allow the view of the entire colon. It also allows doctors to remove a small sample of tissue (biopsy) to detect microscopic inflammation^2,5.

Stool tests To check for infection and hidden blood within the digestive tract^2,3.

Endoscopy Similar to a colonoscopy, the tube is inserted down the throat allowing the examination of the upper portion of the digestive tract².

Imaging tests X-rays, CT scans or MRI scans. Imaging test show pictures of the inside of the body².

There is no cure for CD and UC, but with proper treatment and support, the disease can be effectively managed and may go into remission for long periods of time. Affected children can lead fairly normal lives².
Treatment options include medications, nutritional and diet therapy, and surgery².

Medication for CD and UC in children aim to reduce inflammation².

• Aminosalicylates: used to treat mild or moderate disease^2,6.
• Corticosterioids: stronger anti-inflammatory drugs to treat moderate or severe disease^2,6.
• Inmunomodulators: used as maintenance therapy for severe cases^2,6.
• Biologics: are complex molecules that are produced in living organisms. They function in preventing inflammation and inducing mucosal healing. Biologics include anti-TNF-α (Tumor Necrosis Factor alpha) monoclonal antibodies such as inflixima, among others like adalimumab and certolizumab pegol^2,3.

It is recommended when other therapies have not worked^2,3. Doctors can:

• Remove diseased tissue: after surgery, most people are still able to have bowel movements as usual, through the anus³.
• Reopen a part of the digestive system that is blocked²

• Enteral nutrition: involves consuming all calories from a special formula instead of regular diet².
• Micronutrient deficiencies: your child may require vitamin supplements to maintain their nutritional needs^1,3.