Ulcerative Colitis in Children: Symptoms, Diagnosis and Treatment
Apr 12, 2018
Inflammatory bowel diseases, which are chronic inflammatory conditions that affect the gastrointestinal tract, include ulcerative colitis (UC) and Crohn’s disease (CD). While Crohn’s disease can affect any area of the GI tract, ulcerative colitis involves only the colon, also known as the large intestine. Inflammation associated with UC begins in the rectum and can involve the entire colon.
Nearly 25 percent of patients with IBD are diagnosed as children and about one-third of children with IBD have ulcerative colitis. Over the past several decades, IBD has become increasingly common.
What Causes Ulcerative Colitis?
While the exact cause and a cure for IBD are not yet known, ongoing research shows it relates to a combination of genetics, environmental triggers, and changes in the bacterial composition of the GI tract that leads to an inflammatory response.
What Are the Symptoms and What Else Could It Be?
The most common symptoms of UC include diarrhea with or without blood, abdominal cramping, urgency to stool, and rectal bleeding. Sometimes children may have weight loss or poor growth over time. Other common symptoms can include fatigue, loss of appetite, and anemia caused by ongoing blood loss. Pus, mucus, and bleeding are caused when cells on the surface of the colon lining die and fall off.
Less common symptoms of ulcerative colitis include lesions, joint pain, eye inflammation, liver problems, osteoporosis, rashes, and kidney stones (conditions known as extra-intestinal manifestations).
Because a variety of infections can also cause diarrhea, cramping, or sometimes blood in the stool, testing for infections is usually performed. Irritable bowel syndrome (IBS) is another common cause of change of GI symptoms that must be differentiated from IBD.
How Is Ulcerative Colitis Diagnosed?
Establishing a diagnosis of ulcerative colitis requires a clinic visit and medical exam with a gastroenterologist who specializes in treating patients with GI symptoms. Testing includes blood tests for anemia, elevation of inflammatory markers or signs of ongoing protein loss. Stool tests look for infections and inflammation.
If these labs or the clinical history suggest IBD, both an upper (EGD) and lower (colonoscopy) endoscopy are performed. This procedure involves the use of a small flexible tube with a camera on the end to evaluate the lining of the GI tract. Pictures and tissue samples are obtained while the patients are asleep with anesthesia. These procedures look for inflamed tissue, ulceration, or sites of bleeding to confirm the diagnosis of UC.
How Is It Treated?
While there isn’t a cure for ulcerative colitis, there are a number of well-established and newer medications that are effective for long-term management. These medications aim to heal the prior inflammation in the colon and keep it under control. Improvement in this inflammation helps to eliminate the symptoms and to normalize children’s weight gain and growth. Of equal importance, these therapies can return kids to their normal activities and optimize their quality of life. Children with well controlled ulcerative colitis can participate in their normal sports, extra-curricular activities, and pursuing all of their life goals.
While some patients may experience a disease “flare” where the active inflammation of the colon returns, this can usually be treated and patients can reenter remission. In some cases, despite optimization of medication strategies, the colon remains inflamed and children may require hospitalization. In severe cases not responding to medications, we may have discussions with families about surgical removal of the colon to reduce the risks of severe complications of active UC such as ongoing bleeding (anemia), perforation of the colon, or cancer risk.
In all children with IBD, adequate nutrition is very important. Many children living with ulcerative colitis are deficient in certain minerals and vitamins related to diarrhea or bleeding, so nutritional balance in their diet and input from an IBD registered dietician is vital.
The future is bright for children with both ulcerative colitis and Crohn’s disease. Treatment goals are to get a child into and then maintain a long-lasting, clinical remission. The past decade has had many advances in IBD care and the number of children in remission continues to improve. Managing the disease through good nutritional choices, consistent use of prescribed medications, and communication with your IBD care team will give each child the best chance at living life to the fullest.
The Nationwide Children’s Hospital Center for Pediatric and Adolescent Inflammatory Bowel Disease (IBD Center) uses a multidisciplinary approach to caring for children with ulcerative colitis and Crohn’s disease.
Brendan M. Boyle, MD, is the quality improvement director in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital and an assistant professor of pediatrics at The Ohio State University College of Medicine.
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