Speakers and organizers at Monday's session ‘Advances in Pediatric Gastroenterology' gathered at the conclusion of the presentations.

About one-fourth of all of the 1 million inflammatory bowel disease (IBD) cases in the United States occur in children, mostly in their teens, so the diagnosis and treatment of IBD is an important medical issue.

The latest developments in the treatment and diagnosis of IBD were discussed Monday in the presentation "What's New in the Diagnosis and Management of Inflammatory Bowel Disease" by David Gremse, M.D., during the session "Advances in Pediatric Gastroenterology."

The cause of IBD is commonly associated with genes, because most cases of IBD occur in North America and Europe, but it is becoming more common in Africa. Other factors are the environment and the mucosal immune system, said Dr. Gremse, a Las Vegas-based gastroenterologist.

IBD is usually triggered by a host response to the environment, such as food allergies or acute injury. Those who are not genetically susceptible to the disease tolerate the stimulus with few problems, while those who are genetically susceptible most often have problems, he said.

"There is strong link between genetics and IBD. IBD is a polygenic disease with complex traits, likely contributed to by several genetic risk factors," said Dr. Gremse, adding that 15 percent to 20 percent of patients have a relative with IBD.

The genetic influence is lower in ulcerative colitis than in Crohn's disease, and markers for the disease are being investigated in human gene testing, he said. One marker that can be tested for is NOD2, which is associated with Crohn's, he said.

IBD is most commonly diagnosed by taking a family history, a physical exam and conducting several tests, including CBC, ESR, CRP and Albumin. Also, other etiologies can be excluded with a stool culture or tuberculosis skin test, Dr. Gremse said. It is also important to classify the disease as Crohn's disease or ulcerative colitis, to determine its location and to identify extraintestinal manifestations with liver function tests, and exams of the joints, skin and eyes.

Both Crohn's disease and ulcerative colitis share several symptoms and signs, such as rectal bleeding, abdominal pain, diarrhea, weight loss and growth failure. However, perianal disease is a symptom of Crohn's but not ulcerative colitis, he said.

If IBD is suspected, laboratory tests may provide additional clues to the diagnosis, Dr. Gremse said. Tests may include: a complete blood count, which might show anemia and thrombocytosis; and acute phase reactants, such as the eythrocyte sedimentation rate and C-reactive protein, transaminases and albumin level. Serologic testing is usually not necessary to establish the diagnosis when clinical signs are obvious, but it may be useful in more subtle cases.

Crohn's Disease and ulcerative colitis also have other differences. Crohn's involves any part of the GI tract, the ileum is involved and it is discontinuous. Ulcerative colitis involves only the colon and it is continuous.

Growth failure is also more of a problem with Crohn's. Up to 25 percent of patients do not achieve full adult height potential, and corticosteroids may exacerbate growth impairment, so it is important that interventions are initiated before the completion of puberty, Dr. Gremse said.

The treatment goals for IBD are to maximize therapeutic response and adherence, minimize toxicity, improve the quality of life, promote physical and psychological growth and prevent complications, he said.

"It is important to be sensitive to the fears and concerns of children as you help manage the disease," Dr. Gremse said.

Treatments for moderate to mild cases of Crohn's often include aminosalicylates antibiotics, enteral feeds and steroids, he said. Immunomodulatory and biologic therapy can be used in more severe cases. Surgery is an option for more severe cases that exhibit exsanguinating hemorrhage, perforation and cancer or dysplasia.

For ulcerative colitis, aminosalicylates are used in mild to moderate cases, and corticosteroids are used for moderate to severe cases in induction, Dr. Gremse said.