Diagnosing and Treating Inflammatory Bowel Disease in Children
Inflammatory bowel disease causes inflammation in the small intestine, colon (large intestine), stomach, and other areas of the digestive tract. Symptoms can vary and may include frequent stomach pain, diarrhea, bloody stool, and weight loss.
Accurate Diagnosis Is Key to Treatment
It is important to get an accurate diagnosis for your child, as treatments can differ for Crohn’s disease and ulcerative/indeterminate colitis. Making a diagnosis is like putting together a puzzle. Different pieces -- symptoms, lab work, imaging tests -- help us build a complete picture of your child’s IBD.
Evaluation and Testing
If inflammatory bowel disease is suspected, your child will be tested for:
- Anemia
- Elevated inflammatory markers
- Low protein levels
- Vitamin/nutrient deficiencies (vitamin B12, folate, vitamin D, zinc, iron)
Additional tests and exams include:
- Stool Samples: Tested to rule out other conditions such as gastroenteritis.
- Upper Endoscopy or Colonoscopy: Checks for chronic inflammation in the digestive tract.
- CT Enterography or MR Enterography: Images of the abdomen and pelvis are taken using special methods to increase contrast, allowing us to look for inflammation in the bowel.
Treatment and Ongoing Care
After an initial diagnosis, most children see our pediatric gastroenterologists frequently until their condition is in remission. After your child is in remission, we will see them every two to six months, depending on their condition. Your child’s doctor will perform a physical examination and will assess growth and development. Lab tests ensure the disease is under control and to monitor side effects. Even if your child is feeling well, they should still be seen by their doctor at least once or twice a year.
Crohn's Disease Treatments
Corticosteroids
Prednisolone, prednisone, and budesonide may be prescribed to reduce inflammation. They are used for short periods of time to reduce the risk of long-term side effects.
Immune Suppressants
Azathioprine, 6-mercaptopurine, and methotrexate are used in uncomplicated forms of Crohn's disease to maintain remission of mild-to-moderate disease. They suppress an overactive immune system to heal inflammation.
Biologic Treatments
Infliximab, adalimumab, certolizumab, vedolizumab, and ustekinumab are anti-inflammatory agents that treat inflammation in children with moderate-to-severe Crohn’s disease or forms of Crohn’s disease complicated by fistulas and/or strictures. They are given by injection or by intravenous infusion.
Enteral Nutrition Therapy
Children with certain forms of Crohn's disease may be treated with exclusive or partial enteral nutrition therapy, which replaces regular food with liquid nutritional formulas. Both forms are given for six to 12 weeks. Your child can drink the formula by mouth or it can be given through a nasogastric tube placed through the nose and into the stomach. Enteral nutrition therapy can help avoid the need for steroids or other medicines and their side effects. Nutrition therapy can restore growth, but some children may experience diarrhea in the early stages of treatment.
Ulcerative Colitis Treatments
Anti-Inflammatory Mesalamine
Treats mild-to-moderate forms of ulcerative colitis. It can be taken by mouth or by rectum as a suppository or enema.
Immune Suppressants
Azathioprine, 6-mercaptopurine, methotrexate, and other immune-system-suppressing medications treat moderate-to-severe forms of ulcerative colitis.
Biologic Agents
Infliximab, adalimumab, golimumab, vedolizumab, and other biologic agents treat moderate-to-severe cases of ulcerative colitis.
