what is IBD

What is Paediatric Inflammatory Bowel Disease (IBD)? Essential information, treatments and diet

Inflammatory (inflamed/swollen) bowel disease in kids is on the rise. Also called Paediatric- Inflammatory Bowel disease[NF1] (PIBD), with new Zealand having one of the highest rate of PIBD  5.2 per 100,000 children. For comparison, 11.4 children out of every 100,000 in Asia/Oceania suffer from the diseaseAlthough can occur at any age, most patients are between the ages of 12 to 30 years when the disease begins.

Kappelman, Michael D., et al. "The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States." Clinical gastroenterology and Hepatology 5.12 (2007): 1424-1429.

These subdivided categories are diagnosed by a set of clinical, laboratory, and endoscopic characteristics. There is no single finding that is considered absolutely diagnostic criteria for any one of the three diseases.

What signs of inflammatory bowel disease (IBD) should I look out for in my child?

Parents have a few signs to look out for that can signal Paediatric IBD. These inflammatory bowel disease indicators go over and beyond standard sore tummy issues from eating too quickly or eating too much. The symptoms of IBD are the same for both children and teenagers.

Symptoms of UC:

  • Diarrhoea

  • Blood in stool

  • Abdominal pain

  • Frequent bowel movements

  • Lessening control over bowel movements

  • Nocturnal bowel movements (waking up in the middle of the night to go to the bathroom)

  • Anaemia (low red cell blood count)

  • Poor growth

  • Weight loss

Symptoms of CD:

  • Stomach and abdominal pain

  • Diarrhoea                                      commonest symptoms in 65 to 75% of patients                        

  • Weight loss

  • Poor growth

  • Possible fatigue due to anaemia

  • Blood in the stool (less common than in UC)

  • Signs of disease around rectum and anus (inflamed and/or pus filled skin tags, fistulas, fissures, skin lesions)

  • Recurrent oral ulcers

What could predispose my child to inflammatory bowel disease (IBD)?

 Also called pathogenesis, inflammatory bowel disease is believed the be an outcome of 3 essential, interactive cofactors according to epidemiological studies:

  • Genetic susceptibility (tends to run in families)

  • Enteric microflora

  • Nutritional environment

  • Host immune response

Image credit: Wiki commons 

How will my doctor diagnose my child with inflammatory bowel disease (IBD)?

If you have approached your general practitioner with your child’s stomach problems, they may refer you to a paediatric gastroenterologist specialist or a gastroenterology department like the one run by Starship public children’s hospital in Auckland.

The paediatric gastroenterologist will take a careful history of your child and then give them a thorough physical examination (or order additional tests if your GP has already done this). Blood work to screen for UC and CD signifiers, such as:

  • increased white blood cell count

  • low iron levels

  • increased platelet count

  • nonspecific inflammation markers (CRP, ESR)

  • Stool inflammatory markers (faecal calprotectin)

  • decreased blood levels of proteins (albumin)

  • antibodies more commonly found in IBD patients

 

After the patient’s tests positive or negative for any symptoms, the specialist doctor will then interpret the blood tests to rule out or establish high suspicion of IBD.

A gastroscopy and colonoscopy will be done to confirm the diagnosis and to assess the extent and the degree of the inflammation.

In order to evaluate the full length of the small intestine, sometimes a Wireless capsule endoscopy or a special type of MRI (MR enterography) is performed.

 

How is inflammatory bowel disease (IBD) treated in children?

Treatment may vary according to diagnosis (Crohn’s vs Ulcerative colitis) the location and severity of the disease. The aim of the treatment is first to induce remission, meaning to lower the inflammatory response and then to maintain the achieved remission by keeping the body immune response less active.

 

Treatment may include

Diet (in Crohn’s disease- see below)

Oral or Intravenous corticosteroids

5-ASA/ Aminosalicylates – Mesalazine

Immunomodulators- Methotrexate or Azathioprine

Biologic Anti-TNF – Infliximab or Adalimumab.

Antibiotics

 

How diet can help in treatment of Crohn’s disease?

 

Many studies have shown the link between specific food and the risk of developing Crohn’s Disease. For more than 20 years it is known that remission in mild-moderate Crohn’s disease can be achieved by 8 weeks of exclusive enteral nutrition (EEN). This diet is based on 100% intake of specific liquid formula. Although being very effective, EEN is difficult to follow and to maintain.  

 

Crohn’s Disease Exclusion Diet (CDED), is the first and only clinically proven therapy for the management of Crohn’s disease through whole food diet. The CDED therapy shown to induces remission in early mild-to-moderate CD in children and adults even without the need of other immunosuppression or modulation.

 

The CDED combines a whole food diet specially designed to help you gain control of Crohn’s disease, and a specific Partial Enteral Nutrition (PEN) formula to complete the caloric requirements.

 

As the CDED is based on whole food, it allows access to more variety of food to improve palatability and therefore more tolerated. It helps in maintaining remission and has no side effects.

References

 

1. Sigall-Boneh R et al. Inflamm Bowel Dis., Partial enteral nutrition with a Crohn’s disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease. 2014;20(8):1353-60. doi: 10.1053/j.gastro.2019.04.021.

 

2. Sigall-Boneh R et al. J Crohns Colitis., Dietary Therapy With the Crohn’s Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy. 2017;11(10):1205-1212. doi: 10.1053/j.gastro.2019.04.021.

 

3. Levine A et al., Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial, Gastroenterology 2019;157:440–450. doi: 10.1053/j.gastro.2019.04.021.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034144/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886370/

https://gi.org/topics/inflammatory-bowel-disease-in-children/#:~:text=The%20most%20common%20symptoms%20of,times%20per%20day%20or%20more.

https://pubmed.ncbi.nlm.nih.gov/31170412/

https://companion.crohnsandcolitis.org.uk/your-child/what-treatments-drugs-and-care-are-available-for-my-child

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402682/

https://www.forbes.com/sites/robertglatter/2019/06/24/cure-crohns-disease-with-this-diet/#4cf027206c4c

Useful Links-

IBD is a chronic condition (meaning lingering or long-lasting) that causes sections of the bowel to become inflamed. Three main kinds of inflammatory bowel disease have been identified:

  • Crohn’s disease – where the inflammation can occur anywhere along the gastrointestinal tract, all the way from the mouth to the anus.

  • Ulcerative colitis (UC) – which occurs only in the large intestine (colon), causing ulcers along the inner lining of the colon.

  • Indeterminate colitis (IBD –U) – a chronic disorder with insufficient characterisation to differentiate between Crohn’s and UC by a protracted remitting and relapsing course of symptoms.

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