The
etiology of IBD
is unclear. There are several theories but most agree that IBD is
multifactorial. It is believed that a complex interaction of environmental,
genetic, and immune factors lead to the development of IBD. Approximately 20%
of all inflammatory bowel disease (IBD) first presents in childhood or
adolescence, and approximately 10% of the estimated children with IBD are under
age 17.
As
with adults, the clinical presentation of IBD depends on the site and extent of
mucosal inflammation. IBD is an important cause of gastrointestinal pathology
in children and adolescents. The incidence of pediatric inflammatory bowel
disease is increasing; therefore, it is important for the clinician to be aware
of the presentation of this disease in the pediatric population.
The detection is cumbersome
for the pediatric IBD at presentation due to atypical symptoms or extraintestinal
manifestations (e.g., chronic anaemia, short stature, unexplained fever,
arthritis, mouth ulcers).Laboratory tests, radiology studies, and endoscopic
procedures are helpful in diagnosing IBD and differentiating between Crohn’s
disease and ulcerative colitis.
Serologic testing in
pediatric patients includes traditional IBD serologic markers such as
anti–Saccharomyces cerevisiae antibodies and perinuclear antineutrophil
cytoplasmic antibody, as well as newer antimicrobial antibodies, including antibodies
to outer membrane.
Once diagnosed, the
goal of medical management is to induce remission of disease while minimizing
the side effects of the medication. Specific attention needs to be paid to
achieving normal growth in this susceptible population. Surgical management is
usually indicated for failure of medical management, complication, or
malignancy.
In the last coming
years more treatment, medicines and drugs option have become available
including antibiotics, 5-aminosalicylate, corticosteroids, immunomodulators and
biological agents. When anti-tumor necrosis factor (TNF)-α became available to
patients with IBD, the risk for surgery is less in comparison to earlier, with
the use of anti-TNF-α treatment the risk of surgery has decreased
significantly.
It should be
appreciated that in children as well as in adults Crohn’s diseases encompasses
a varied range of disease phenotypes and severities and therefore optimal
patient selection, timing and therapy helps in proper clinical judgment.
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