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