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- Sarah R. Glick, MD*
- Ryan S. Carvalho, MD†
- *Wright State University Boonshoft School of Medicine, Children's Medical Center of Dayton, Dayton OH.
- †The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Author Disclosure
Drs Glick and Carvalho have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.
Objectives
After completing this article, readers should be able to:
Develop a differential diagnosis and plan an initial evaluation for the child or adolescent who presents with bloody diarrhea and abdominal pain.
Recognize that growth failure and pubertal delay may be an initial presentation of Crohn disease.
List the extraintestinal manifestations of inflammatory bowel disease (IBD).
Discuss the genetic advances in understanding the pathogenesis of IBD.
Describe the current treatments for IBD and the common adverse effects.
Introduction
IBD is a complex, multifactorial disease characterized by chronic inflammation in the intestinal tract of a genetically predisposed host. The spectrum of IBD in children primarily includes ulcerative colitis (UC) and Crohn disease (CD). With pediatric patients now accounting for 20% to 25% of newly diagnosed cases, it is becoming increasingly important for pediatricians to recognize the symptoms of IBD. (1) In this review, we discuss the epidemiology, clinical presentation, diagnosis, and complications of IBD, with specific emphasis on growth failure and pubertal delay because these are unique manifestations in children. We also describe newer, less invasive diagnostic techniques and current trends in management and advances in the pharmacologic treatment of affected children.
Epidemiology and Demographics
The epidemiologic patterns of pediatric IBD have evolved over the past few decades, with significant increases in both incidence and prevalence. The current incidence is 5 to 11 per 100,000 children, with a recent statewide survey from Wisconsin reporting the annual rate of diagnosis as 4.56 per 100,000 for CD and 2.14 per 100,000 for UC. (2) Canadian studies have reported an acceleration in new diagnoses from 9.5 per 100,000 in 1994 to 11.4 per 100,000 in 2005. The most significant increases …
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