Friday 4 May 2018

Pediatric inflammatory bowel disease (IBD): A concern for the Future


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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