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[Inflammatory bowel disease in children]
1Univerzitetska decja klinika, Beograd.
Insights
Paediatric chronic inflammatory bowel diseases include Crohn's disease and ulcerative colitis, alongside other conditions. Management varies, with early azathioprine for Crohn's and nutritional therapy for allergic colitis in infants.
Area of Science:
- Pediatric gastroenterology
- Inflammatory bowel disease (IBD) research
- Chronic gastrointestinal disorders in children
Context:
- Paediatric chronic inflammatory bowel diseases (IBD) encompass a spectrum of conditions beyond Crohn's disease (CD) and ulcerative colitis (UC).
- These include allergic colitis in infancy, hypereosinophilic syndrome colitis, Behcet colitis, and microscopic colitides.
- Understanding the nuances of these diverse conditions is crucial for accurate diagnosis and effective management in children.
Purpose:
- To delineate the varied landscape of paediatric chronic inflammatory bowel diseases.
- To highlight specific characteristics and therapeutic considerations for conditions like paediatric CD and UC.
- To differentiate allergic colitis in infancy from UC, addressing potential diagnostic and therapeutic challenges.
Summary:
- Paediatric Crohn's disease (CD) often presents with inflammatory and obstructive patterns, frequently necessitating early azathioprine for steroid-dependent or refractory cases.
- Surgical resection may be considered in adolescence to facilitate pubertal development.
- Paediatric ulcerative colitis (UC) commonly manifests as pancolitis, associated with a higher colectomy rate, with ongoing debate regarding optimal surgical approaches (restorative proctocolectomy vs. ileo-anal pull-through).
- Allergic colitis in infancy can mimic UC, leading to diagnostic confusion; its treatment is primarily nutritional.
Impact:
- Provides a concise overview of differential diagnoses in paediatric IBD.
- Informs clinical decision-making regarding the timing of immunosuppressive therapy and surgical interventions in paediatric CD.
- Clarifies the distinct aetiology and management of allergic colitis in infancy compared to UC.
- Highlights the need for tailored therapeutic strategies based on specific paediatric inflammatory bowel disease diagnoses.
Abstract:
Beside Crohn's disease (CD) and ulcerative colitis (UC), paediatric chronic inflammatory bowel diseases encompass variety of different inflammatory conditions: allergic colitis in infancy, colitis of hypereosinophilic syndrome, Behcet colitis, microscopic colitides etc. Paediatric CD characterises predominance of inflammatory and obstructive disease variant. Because of their growth suppression an early introduction of azathioprine in steroid dependent and steroid refractory cases is frequently indicated. In teenage period resection procedures may be an elective and initial therapeutic option due to necessity of proper pubertal mental and physical development. Paediatric UC frequently manifests initially as pancolitis what indicates higher rate of colectomy rate. Therapy is still dispute about an optimal surgical procedure: restorative proctocolectomy or ileo-anal pull through techniques. Allergic colitis in infancy may mimic ulcerative colitis and rises a possibility of diagnostic and therapeutic confusions. Its treatment is strictly nutritive.