وصف
Pediatric Inflammatory Bowel Disease (IBD) encompasses chronic inflammatory conditions of the gastrointestinal tract, primarily Crohn's disease and ulcerative colitis, affecting children and adolescents. Symptoms include abdominal pain, diarrhea, weight loss, and growth failure. Early diagnosis and management are crucial for improving outcomes and quality of life. Treatment typically involves medication to control inflammation, nutritional support, and sometimes surgery. Multidisciplinary care, including gastroenterologists, dietitians, and mental health professionals, is essential for comprehensive management of pediatric IBD.
ملخص
- Inflammatory Bowel Disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract with unknown etiology, encompassing ulcerative colitis and Crohn's disease. These disorders are considered autoimmune and characterized by recurrent exacerbations and remissions.
- Ulcerative colitis is localized to the colon with diffused mucus inflammation, generally not involving muscle or serosa. It can manifest as proctitis, proctosigmoiditis, left-sided colitis, extensive colitis, or pancolitis, with extensive colitis being more common in pediatric patients.
- Crohn's disease is characterized by patchy, transmural inflammation affecting any part of the GI tract from oral cavity to anus, including all layers of the bowel. It can be ileal, colonic, ileocolonic, or upper GI, and is an inflammatory, fistulizing, and stricturing disease.
- Pediatric IBD is classified by age: pediatric onset (under 17), early onset (under 10), very early onset (under 6), toddler/infant onset (under 2), and neonatal (under 1). This classification helps prioritize causes, with genetic and immunodeficiency causes more likely in infantile IBD.
- Diagnosis involves detailed clinical history, biochemical, radiologic, endoscopic, and histopathological evaluations. A thorough history includes bowel habits, abdominal pain, family history, and extra-intestinal manifestations like arthritis or uveitis.
- Common IBD symptoms include diarrhea, constipation, abdominal pain, rectal bleeding, urgency, and tenesmus, along with systemic symptoms like fever, loss of appetite, weight loss, growth failure, and fatigue. Physical examination assesses general wellbeing, anthropometry, and perineal area.
- Basic investigations include surrogate markers for gut inflammation like CRP and ESR, and fecal calprotectin for intestinal inflammation. Specialized blood tests like ANCA and ASCA can help distinguish ulcerative colitis from Crohn's disease.
- Imaging tests include colonoscopy and upper GI endoscopy, CT or MR enterography for small bowel involvement, and capsule endoscopy. Multiple biopsies should be taken during endoscopy, including from healthy-looking areas, and sent for histopathology.
- Management goals are to achieve clinical, endoscopic, and histopathological remission, prevent flare-ups, maintain normal growth and nutrition, and improve quality of life. Treatment options include nutritional management, pharmacological options, biologics, and surgery.
- Initial management of Crohn's includes dietary intervention (exclusive enteral nutrition) and/or corticosteroids. For ulcerative colitis, aminosalicylates are used, while severe cases may require IV steroids. Immunomodulators are used for maintenance, and biologics are considered if there is no response to conventional treatments.
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