Inflammatory Bowel Disease

Abstract

Paediatric inflammatory bowel disease (IBD) (ulcerative colitis, Crohn’s disease, inflammatory bowel disease-unclassified) is more common in the developed world. In some parts of the Western World, its incidence is stable, but in Northern Europe, it is still increasing, especially that of Crohn’s disease. The presentation and symptoms are similar to adult-onset disease, but the rate of extensive disease is much higher in children. General symptoms and significant growth retardation may occur with IBD but are more common in Crohn’s disease. Extraintestinal symptoms in various organ systems occur in a significant percentage of patients. Prompt diagnostic work-up is required in a symptomatic patient to establish the correct diagnosis and to avoid medical problems associated with delayed diagnosis. The initial treatment of IBD is medical, and the aim is to achieve remission of symptoms by controlling the bowel inflammation. The medical treatment of IBD has evolved significantly during recent decades and involves 5-ASA preparations, steroids, immunomodulators and biologics. Modern therapeutic strategies have decreased the complications of medical treatment significantly. In ulcerative colitis, urgent surgical treatment is indicated in acute conditions such as toxic megacolon or severe bleeding. In Crohn’s disease, urgent surgery may be required in cases with bowel obstruction, perforation and intra-abdominal abscess or toxic megacolon. Elective surgery in IBD is considered in complicated disease course or refractory disease. In ulcerative colitis, restorative proctocolectomy is the surgical treatment of choice and potentially curative. The outcomes of surgery in recalcitrant ulcerative colitis are generally satisfactory, and the quality of life of the operated patients is similar to healthy peers. In Crohn’s disease, elective indications for surgery are severe strictures and perianal disease, significant prepubertal growth delay and complications of or unresponsiveness to medical therapy. Crohn’s disease cannot be cured by surgery and patients commonly require continuous medical treatment despite successful surgery. The management of paediatric Crohn’s disease focuses on controlling gut inflammation and optimising growth, development and quality of life.