State of the art: IBD in children

Genetic factors appear to be particularly important in the pathogenesis of childhood inflammatory bowel disease (IBD). The major presenting feature of ulcerative colitis in young patients is almost uniformly bloody diarrhea, whereas the initial symptoms of Crohn's disease are more varied. In compari son to adults, childhood ulcerative colitis is more often extensive. Anatom ic distribution of Crohn's disease is similar to adult cohorts. Two serolog ical tests, antineutrophil cytoplasmic antibody (ANCA) and anti-Saccharomyc es antibody (ASCA) have been suggested to be helpful in differentiating the type of pediatric IBD. However, only Crohn's colitis and ulcerative coliti s present difficulties in differentiation; yet such patients demonstrate co nsiderable overlap with respect to ANCA and ASCA status. The clinical cours e of IBD occurring in childhood is variable, as in adults. Unique to pediat ric populations, and to Crohn's disease particularly, is the potential comp lication of growth impairment and accompanying pubertal delay. Direct growt h-inhibiting effects of cytokines released from the inflamed bowel, as well as chronic undernutrition, and effects of corticosteroid therapy on the gr owth hormone-insulin growth factor I axis contribute to its pathogenesis. O ptimization of treatment of intestinal inflammation, and provision of adequ ate nutrition are of paramount importance in preventing or remedying growth impairment. Growth is a measure of the success of therapy. Control of gast rointestinal symptoms by long-term corticosteroid use, which impedes linear growth, does not constitute successful medical management. Optimal treatme nt of intestinal inflammation encompasses immunomodulatory therapy, nutriti onal therapies, and if appropriate, resection of the diseased bowel. (C) 20 00 Prous Science. All rights reserved.