What is IBD?

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IBD: Inflammatory Bowel Disease

Inflammatory bowel disease includes both Crohn's disease and ulcerative colitis.

Crohn's disease may cause inflammation of any portion of the digestive tract from the mouth to the anus. The inflammation caused by Crohn's disease can be seen throughout the entire thickness of the intestinal wall. These inflamed areas can appear in various spots (skip lesions). Often you will hear the term Crohn's colitis or ileitis. Keeping in mind that "itis" means inflammation, colitis is inflammation of the colon (large intestine/bowel), ileitis is inflammation of the ileum (small intestine/bowel). These terms are used to describe the location of the disease.

Ulcerative colitis affects the large intestine. The inflammation occurs on the inner lining of the wall of the intestine. Ulcerative proctitis, a form of ulcerative colitis, is confined to the end of the large intestine, rectal area.

More than one million people in the United States suffer from IBD. At least 100,000 of them are children. Twenty- five percent of all pediatric cases of IBD are diagnosed in children between the ages of six months and 12 years. Symptoms may begin slowly or develop quite suddenly, and may include diarrhea, abdominal pain, rectal bleeding, and fever. Decreased appetite and weight loss often accompany the disease.

Crohn's disease and ulcerative colitis often affect not only the intestines, but other organs of the body as well. Children with these diseases may have disorders of the skin, joints, and liver, and frequently exhibit growth failure and delay in sexual maturation. These complications may require treatment by a host of medical subspecialists.

Symptoms range from mild to severe. Available medical treatments control the symptoms, but do not provide a cure. While surgery in Crohn's disease is only palliative, surgery offers a definitive cure for ulcerative colitis. The cause of Crohn's disease and ulcerative colitis has been shown by researchers to involve the possible interaction between a person's immune system, their genetic makeup and their response to the environment.

Diagnosis and Testing

It is helpful to become familiar with some of the tests your child may have during his/her course of treatment. These include blood tests, X-rays, endoscopies, and ambulatory motility studies. You will receive specific instructions from your physicians for any test that are scheduled.

Blood tests are the most frequent, and may be required regularly. The results of these tests provide an objective way for doctors to follow a patient's progress as well as a way to measure nutritional status. Blood tests of certain immunological markers can also help confirm a diagnosis of IBD, and at times can help differentiate between Crohn's disease and ulcerative colitis.

X-rays are usually done to confirm the diagnosis and evaluate the extent of inflammation. The most common of these is an upper GI series with a small bowel follow- through. This procedure provides doctors with information about your child's esophagus (food tube), stomach, and small intestine. Patients must fast from midnight until the time of the test. After your child drinks a large glass of liquid contrast, flavored to make it easier to drink, a series of X-rays are taken. This study usually takes between two-and-a-half to three hours.

Endoscopy provides further information. There are two types of endoscopies - colonoscopy and upper endoscopies. In a colonoscopy, a tube is inserted into the rectum, and moved along the colon to allow visualization and biopsies of the entire large intestine and the end of the small intestine. In an upper endoscopy, the tube is inserted through the mouth and passed into the stomach and small intestine, providing information about the esophagus, stomach, and the duodenum, the first portion of the small intestine. Patients having these tests are given medicine (intravenous sedation or anesthesia) to eliminate discomfort.

Capsule "minicamera" endoscopy is a video capsule that is the size of a vitamin. After it is swallowed the doctor can examine portions of your small intestine that cannot be easily seen from an upper endoscopy. The pictures are sent to a recorder that you wear around your waist on a belt. These images are then downloaded and reviewed by your doctor. The capsule is excreted in your stool normally and without discomfort.

An ambulatory motility study is a test which allows doctors to measure the movements of the digestive tract over a 24-hour period. In this test a thin plastic tube is inserted through the nose into the stomach at the time of your child's upper endoscopy. The tube is secured to his/her chest with tape, and attached to a small recorder worn around the waist. The patient goes home with the tube in place, and returns the next day to have it removed, which only takes a few seconds.

Nutrition and IBD

A healthy diet is important for everyone, especially for children with IBD. These children must be properly nourished if normal growth is to occur.

At times, additional types of nutritional support are indicated:

• Dietary supplements
• Nasogastic (NG) tube feedings - a tube inserted through the nose down into the stomach to infuse nutrition
• Gastrostomy Tube (GT) Feeds - a tube is inserted through the abdominal wall directly into the stomach to infuse nutrition
• Total Parental Nutrition (TPN) - nutrients provided through an intravenous line

Note: Both NG tube feedings and TPN can be used at night, allowing the child to function normally during the day.

It is critical to be aware of the major role that nutrition plays in the growth and development of children with IBD. Occasionally, children with IBD have benefitted from injections of Human Growth Hormones. We encourage you to discuss any concerns with your physician.

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"What is IBD?" is from our brochure, The Inside Story.