Pediatric inflammatory bowel disease

Abstract

This manuscript highlights recent advances relevant to pediatric patients with inflammatory bowel disease. Four areas are presented: growth failure, diagnosis and pathobiology, therapy, and clinical associations. Articles most likely to affect investigators and clinicians working on issues of importance to children and adolescents with Crohn's disease and ulcerative colitis were selected. Growth failure is a common and frequently serious problem in the pediatric population affected by inflammatory bowel disease. In 1993, both prospective and retrospective studies evaluated the effects of various treatment regimens. The role of pharmacotherapy and hormones in modifying alterations of growth were determined. Cytokines were studied as possible diagnostic tools in the clinical evaluation of disease and their role in the pathogenesis of mucosal inflammation became somewhat better defined, but much more complicated. The relationship between immunology, genetics, and clinical disease became clearer with the introduction of antineutrophil cytoplasmic antibodies in differentiating between Crohn's disease and ulcerative colitis. Therapy with immunosuppressive agents and reassessment of the role of surgical management of inflammatory bowel disease in children were the major therapeutic advances, although new agents appropriate for children are on the horizon. An interesting series of case reports highlighted aspects of the disease that are unique to the pediatric population.