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Inflammatory bowel disease in infancy: an increasing problem?
I M Dady1, A G Thomas, V Miller
1Department of Paediatric Gastroenterology, Booth Hall Childrens' Hospital, Manchester, England.
Insights
Infantile inflammatory bowel disease (IBD) presents a diagnostic challenge, often unresponsive to standard treatments. This study highlights severe, treatment-resistant IBD cases in infants, emphasizing the need for further research.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Infant Health
Background:
- Intractable diarrhea in infancy can indicate severe gastrointestinal pathology.
- Inflammatory bowel disease (IBD) is rare in early infancy.
- Distinguishing IBD from other causes of infant diarrhea is crucial.
Observation:
- Seven infants presented with intractable diarrhea and endoscopically confirmed IBD between 1990-1993.
- Patients showed varied symptoms including mouth ulcers, upper GI inflammation, villous atrophy, and colitis.
- Disease was unresponsive to bacterial infection exclusion and whole protein exclusion diets.
Findings:
- Significant clinical and histological heterogeneity was observed among the seven patients.
- All infants required parenteral nutrition due to the severity of their condition.
- Treatment outcomes were poor: only one patient responded to steroids, two needed colectomy, and two died.
Implications:
- Infantile IBD, distinct from infectious or milk-intolerance causes, is a rare but serious condition.
- The increasing prevalence of IBD in infancy warrants further investigation.
- Management of severe infantile IBD requires specialized, often intensive, care and highlights treatment limitations.
Abstract:
Seven children with intractable diarrhoea of infancy seen between 1990 and 1993 developed endoscopically established inflammatory bowel disease unrelated to bacterial infection and not responsive to whole protein exclusion. Mouth ulcers were present in two patients, endoscopic upper-gastrointestinal-tract inflammation in two, villous atrophy in six, and chronic nonspecific colitis in all seven. There was considerable clinical and histological heterogeneity. All patients required parenteral nutrition. Steroid therapy was completely successful in only one child, while two underwent colectomy, and two died. Previously described cases other than those due to infection or milk intolerance have been rare and sporadic. The prevalence of inflammatory bowel disease in infancy is unknown but appears to be increasing.