Inflammatory bowel disease: A pediatric perspective

Mathias E^*
*Correspondence: Mathias E, Department of Pathology, Nantes University, Nantes Cedex, France, Tel: 1359768542, Email:

Introduction

IBD, which is most frequently classified as Ulcerative Colitis (UC) and Crohn's Disease (CD), tends to be more prevalent in northern hemisphere countries and industrialiser countries. It is unknown what the actual global incidence of paediatric IBD. Twenty five percent to thirty percent of CD patients and twenty percent of UC patients who have IBD are under the age of twenty. Annual incidence rates of UC and CD have been reported to range from 0.5 to 4.3 per 100,000 people, respectively. According to some statistics, the annual incidence of CD is increasing and is already on par with or even surpassing that of UC. Between 1960 and 1990, there was a considerable rise in the overall incidence of IBD.

Despite being less common in children than in adults, the frequency is rising, with the most current estimates placing it at 47 per 100 000. The key contributor to gastrointestinal pathology in children and adolescents is inflammatory bowel disease. The prevalence of paediatric inflammatory bowel disease is rising, thus it is important for the clinicians to understand how this disease manifests in this demographic section of the population. The diagnosis of inflammatory bowel disease and the distinction between crohn's disease and ulcerative colitis can be made with the aid of laboratory tests, radiological studies, and endoscopic procedures. Medical care after a diagnosis aims to minimise pharmaceutical side effects while inducing remission of the disease. The achievement of normal growth in this sensitive group requires special consideration.

Typically, complications, malignancy, or failure of medicinal therapy call for surgical management. The description of algorithms for the diagnosis, assessment, and therapy of paediatric inflammatory bowel disease is therefore important. In addition to discussing the complex problem of juvenile inflammatory bowel illness, one of the recent studies also discusses the specific psychosocial problems that these patients face. Growth retardation was briefly covered earlier in this article, but it merits more attention. It could already exist at the time of diagnosis or develop as a result of therapy. Reduced physical activity, chronic corticosteroid usage, and inadequate nutrition all contribute. In order to prevent growth failure from affecting a patient's treatment plan, it is crucial to get a thorough growth history and regularly monitor growth parameters.

Description

More than 85% of patients with IBD exhibit impaired growth at the time of diagnosis, making height growth rate is the most crucial factor in the diagnosis of growth impairment. Nutritional deficiency is primarily caused by inadequate intake, which can result from anorexia or from a dread of food stemming from the connection between eating and pain. The epiphyseal fusion of long bones and development through the tanner phases are two areas where undernutrition causes delays in skeletal and sexual maturation. Corticosteroids may make maturation and growth even more challenging. Malnutrition, a sedentary lifestyle, the use of corticosteroids, and an overproduction of inflammatory cytokines are factors that lead to aberrant bone mineralization. Corticosteroids block osteoblasts, hinder calcium absorption in the intestine, and compete with growth hormone. Radiologic examinations can be used to diagnose bone disease. A dual energy X-ray absorptiometry study is very useful and the results result should be interpreted based on the bone age or height age, not chronological age for accurate estimation of the extent of bone disease.

Pediatric IBD patients struggle with a wide range of medical issues in addition to considerable psychological pressures. Due to the chronic nature of the illness, emotional and behavioural problems are frequently present. Exacerbation of a condition can cause unanticipated changes in lifestyle. There is a high prevalence of anxiety, depression, and antisocial and dependent behaviour. Concerns about how they differ from other kids and how their condition is progressing, such as a recurrence or complications that require surgery or stomas, can contribute to anxiety and depression. Difficulty interacting with peers may result from school absenteeism and may be compounded by low self-esteem due to delayed growth and development. Finally, the youngster may experience significant psychosocial stress. Chronic illnesses could alter the work schedules and increased medical expenditure.

It's crucial to keep in mind the educational requirements of kids with IBD. Attendance at school may suffer as a result of this illness. This could result in the youngster falling behind in their academics if it is not anticipated and handled properly. If the educational requirements of the child with a chronic illness are disregarded, all of the aforementioned issues may become worse. One aspect of providing long-term care for children with IBD is evaluating how well the child has adjusted to the disease.

There are numerous assessment instruments available, with the majority of models concentrating on evaluating social support, coping abilities, effects on everyday activities, and body image. It has been demonstrated that age, education, and gender have an impact on these broad categories, which are used to evaluate quality of life. Preparation of the detailed medical history, including test results and care of specialized gastroenterologists is essential [1].

A dysregulated mucosal immune response to the intestinal microbiota in genetically susceptible hosts could potentially result in inflammatory bowel disease. Children can exhibit the typical signs of weight loss, discomfort in the stomach, and bloody diarrhoea, but many also exhibit uncommon symptoms such as isolated poor growth, anaemia, or other extraintestinal indications. Once IBD has been identified, the objectives of therapy include reducing the symptoms, restoring growth, and normalising quality of life.

When managing IBD in children and adolescents, it's important to pay special attention to how the condition affects their bone health, psychological functioning, and growth and development. A recent study presented an overview of the epidemiologic characteristics, aetiology, diagnosis, and treatment of IBD in kids and teens [2].

Chronic Inflammatory Bowel Disease (IBD), once unusual in paediatric practise, is now more frequently identified in kids of all ages. In actuality, 20% of people with Ulcerative Colitis (UC) and 25%to 30% of all patients with Crohn's Disease (CD) appear before the age of 20. Four percent of pediatric IBD occurs before the age of 5 years, with a peak age of onset in the late adolescent years. The prevalence of IBD in children has long been recognised; the first patient with regional enteritis that crohn described was a 16 years old boy. IBD has become one of the most prominent chronic diseases affecting children and adolescents as a result of the growing identification of the condition among paediatric patients [3].

Conclusion

Children may display strong extraintestinal indications, such as growth failure and delayed puberty, in addition to the typical gastrointestinal symptoms of diarrhoea, stomach pain, weight loss, anaemia, joint problems, and rectal bleeding. The absence of controlled clinical trials, the scarcity of pediatric specific medications, the psychological problems that IBD-affected children and adolescents experience are some additional concerns that are specific to paediatrics. Because of these particular issues, treating young IBD requires a different medicinal strategy than treating adult onset IBD.

References

1. Diefenbach, Karen A, and Christopher K Breuer. "Pediatric inflammatory bowel disease." World J Gastroenterol 12 (2006): 3204.

   [Crossref] [Google Scholar] [PubMed]

2. Rosen, Michael J, Ashish Dhawan, and Shehzad A Saeed. "Inflammatory bowel disease in children and adolescents." JAMA Pediatr 169 (2015): 1053-1060.

   [Crossref] [Google Scholar] [PubMed]

3. Baldassano, Robert N, and David A Piccoli. "Inflammatory bowel disease in pediatric and adolescent patients." Gastroenterol Clin North Am 28 (1999): 445-458.

   [Crossref] [Google Scholar] [PubMed]