Pediatric inflammatory bowel disease in the emergency department: managing flares and long-term complications

Area of Science:

• Gastroenterology
• Pediatric Medicine
• Emergency Medicine

Background:

• Inflammatory bowel disease (IBD), encompassing Crohn disease and ulcerative colitis, affects both children and adults.
• Pediatric-onset IBD exhibits distinct characteristics in disease type, location, progression, and sex distribution compared to adult IBD.
• A significant proportion, 20%–30%, of IBD diagnoses occur in childhood.

Observation:

• Children with IBD are more prone to extraintestinal manifestations, commonly including aphthous ulcers, joint involvement, and growth delay.
• IBD flares often necessitate intravenous steroid treatment and hospitalization.
• Acute emergencies in IBD can include toxic megacolon, intestinal obstruction, and perforation.

Findings:

• Steroid administration can mask the clinical signs and symptoms of underlying abdominal emergencies in IBD patients.
• Emergency clinicians face unique diagnostic challenges when evaluating pediatric IBD patients, particularly during acute exacerbations.
• Recognizing the potential for obscured diagnoses due to steroid use is critical for timely intervention.

Implications:

• Enhanced awareness among emergency clinicians is crucial for accurately diagnosing and managing acute abdominal emergencies in pediatric IBD.
• Early recognition of steroid-masked symptoms can prevent delayed treatment of life-threatening complications.
• This understanding supports improved clinical protocols for evaluating children with IBD presenting to emergency departments.