Pediatric Inflammatory Bowel Disease (IBD): Basics

00:02 In this lecture, we’re going to review the basics of inflammatory bowel disease.

00:07 Whole books have been written about this, but we’re going to try to cover the features that are most likely to show up on a multiple choice exam.

00:14 So inflammatory bowel disease, a few things we need to understand.

00:19 The incidence is increasing in the United States.

00:22 This is probably because fewer and fewer children are exposed to things that are training their immune system in that first year of life not to attack itself.

00:34 25% of patients are going to present in childhood or adolescence.

00:38 So this is somewhat an adult disease, but also it’s a pediatric disease and there some differences.

00:46 Environmental triggers in genetically predisposed individuals are what caused this disease.

00:53 It’s a combination of environment and genetics.

00:56 Clearly, poor health, restricted growth, and adverse psychological well-being are consequence of inflammatory bowel disease.

01:05 This is a disease where we have to deal not only with the intestine, but the person as a whole.

01:12 So what part of the bowel are affected? Well, it’s different depending on which type of inflammatory bowel disease you have, be it Crohn’s or ulcerative colitis.

01:22 Crohn’s disease can affect any part of the GI tract from mouth to anus.

01:29 Ulcerative colitis only affects the colon.

01:34 So the epidemiology of IBD is that there is a bimodal peak of when this disease is first recognized.

01:41 With an uptake during the late childhood period and then into young adulthood and then fewer diagnoses until the 40s, 50s and 60s.

01:54 While it is rare, I have even seen children diagnosed with inflammatory bowel disease as early as year of age.

02:02 But these are the peak ranges when this diagnosis is made and because I’m speaking about pediatrics, I’m going to talk about the younger group.

02:11 Remember that the mean age of diagnosis in the United States is in children, so it’s appropriate for us to be discussing this problem.

02:18 The average age being 12-1/2.

02:21 And 20% of cases in children are diagnosed before 10 years of age.

02:27 So we have to think about this even in the young kids.

02:30 So who’s affected more often? Well, in ulcerative colitis, it’s more often affected men than it affects women.

02:39 Inflammatory bowel disease is more prevalent in the first world.

02:44 Developing countries have a lower rate of this problem.

02:47 This probably relates to early childhood exposure to infections and especially to worm infections which seem to be protective for developing the illness.

02:58 So risk factors for inflammatory bowel disease include a positive family history, which is seen in roughly one in four patients.

03:07 Patients with Jewish ancestry are at increased risk for developing inflammatory bowel disease.

03:13 Patients who are exposed to smoke have an increased risk of development of Crohn’s disease.

03:19 But ironically, smoke exposure decreases risk of developing ulcerative colitis.

03:25 I would not propose that you encourage patients to smoke because of a decreased risk of ulcerative colitis, but that is something we’ve seen.

03:32 Interestingly, appendectomy may be protective for the development of Crohn’s disease.

03:37 Nobody has a clue why.

03:40 So inflammatory bowel disease is going to present a little bit differently depending on whether the disease is Crohn’s disease or ulcerative colitis.

03:49 However, there are some consistencies between the two.

03:52 All of these patients will present with abdominal pain, weight loss, and intermittent fevers.

03:58 Patients with Crohn’s disease will have diffuse or right lower quadrant crampy abdominal pain.

04:04 They may have non-bloody, melanotic or frank blood in their diarrhea.

04:09 They will see more perianal disease, so you’ll see tags, fissures, other problems, fistulas around the anal area.

04:21 So a perianal exam is important on these patients.

04:24 And they also can develop recurrent aphthous ulcers in the mouth.

04:28 Patients with ulcerative colitis will develop diffuse abdominal pain.

04:34 They may develop bloody diarrhea and they may also develop fecal urgency and increased frequency.