Inflammatory Bowel Disease (IBD) is characterized as a long-term inflammatory condition affecting the gastrointestinal tract without a specific identifiable cause, such as infection. The condition results from an overactive immune response triggered by food, bacteria, and other contents within the gastrointestinal (GI) tract. This exaggerated immune reaction leads to persistent inflammation and damage to the intestines, manifesting as symptoms like abdominal pain, diarrhea (often with blood), weight loss, and slowed growth. In the United States, over 3 million individuals are impacted by IBD, with approximately a quarter of cases emerging in children.
Understanding Inflammatory Bowel Disease (IBD)
Variants of Inflammatory Bowel Disease
There exist two primary forms of inflammatory bowel disease: Crohn’s disease (CD) and ulcerative colitis (UC). Ulcerative colitis predominantly induces inflammation in the large intestine (colon), while Crohn’s disease can affect any part of the GI tract, encompassing areas like the mouth, esophagus, stomach, small intestine, and colon. Most patients diagnosed with Crohn’s disease exhibit inflammation in the terminal ileum (the last part of the small intestine) and the large intestine. Some individuals may receive a diagnosis of indeterminate colitis, characterized by features aligning with both Crohn’s disease and ulcerative colitis without clear differentiation. The unique subset of very early onset inflammatory bowel disease (VEOIBD) pertains to children under six years old, showcasing varied disease presentations that necessitate comprehensive evaluation for potential alternative causes.
- The exact cause of IBD remains uncertain, although a blend of genetic predispositions and environmental factors likely contributes.
- Patients with IBD might experience inflammation in other body regions, including the skin, joints, eyes, or liver.
- It is essential to distinguish between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), as IBD entails more severe symptoms such as abdominal pain, rectal bleeding, and weight loss, differing from the usually milder symptoms observed in IBS.
These distinguishing features emphasize the significance of consulting a pediatric gastroenterologist or IBD specialist for appropriate care and management strategies tailored to each patient's needs.
- Immunosuppressants: Immunosuppression medications function by suppressing the immune system. They are typically prescribed for short-term use to induce remission in severe cases of Crohn’s disease and ulcerative colitis that are challenging to manage with conventional treatments. Regular monitoring of blood medication levels, kidney function, and electrolytes is necessary due to associated risks such as infections.
- Steroids (prednisone, budesonide), 6-mercaptopurine, methotrexate, cyclosporin, tacrolimus
- Biologics: Biologics, complex proteins engineered to block specific targets and control inflammation, are derived from living sources like animal or human cells. These medications include antibodies and various drugs with distinct working mechanisms and administration routes. Biosimilars, based on existing biologics, are not exact replicas but function similarly. Biologics are administered via injection or infusion into a vein and require routine follow-up care to maintain safety. Factors considered before prescribing biologics include effectiveness, administration method, patient preferences, and medication costs.
- Anti-Tumor Necrosis Factor (TNF) Agents: Anti-TNF agents, like Infliximab (Remicade®), Adalimumab (Humira®), Golimumab (Simponi®), and Certolizumab pegol (Cimzia®), block tumor necrosis factor (TNF) to control inflammation and improve IBD symptoms, promoting mucosal healing. While these medications, FDA-approved for children with IBD, are highly effective, rare side effects like infections, allergic reactions, autoimmune responses, lymphomas, and skin cancers may occur.
- Vedolizumab and Ustekinumab: Vedolizumab (Entyvio®) targets integrin proteins on intestinal blood vessel surfaces to inhibit inflammatory cell migration into the intestines. This treatment is approved for adults with moderate to severe ulcerative colitis and Crohn’s disease but not yet FDA-approved for pediatric IBD; it is considered when standard medications fail. Ustekinumab (Stelara®) blocks interleukin 12 and 23, also used when FDA-approved medications are ineffective. It poses a slight risk of infections, particularly sinusitis, but is largely deemed safe.
- Importance of Good Nutrition: Maintaining proper nutrition is vital during childhood and adolescence to support growth, development, and immune system function. IBD can impact nutrition by causing poor appetite, malabsorption, and increased caloric needs due to chronic inflammation.
- Diet Therapies for IBD: Various dietary interventions can complement medication treatment. Exclusive enteral nutrition (EEN), Crohn’s disease exclusion diet (CDED), and the specific carbohydrate diet (SCD) are utilized to manage IBD symptoms effectively. EEN is proven to induce remission in pediatric Crohn’s disease, while CDED targets specific nutrient restrictions to alleviate gut inflammation.
- Dietary Fiber and Weight Management: Adjustments in dietary fiber intake may be necessary based on inflammation severity, with low-fiber diets aiding gut healing. In cases of weight loss, high-calorie, high-protein diets, including dairy and meat food groups, are recommended. Nutrition shakes or temporary feeding tubes can supplement nutrient intake if eating challenges persist.
- Supplementation and Vitamins: Monitoring and supplementing with essential nutrients like iron, calcium, vitamin D, and folate is crucial, especially during childhood and adolescence. Probiotics, curcumin (turmeric), and specific nutrition supplements may be recommended based on individual needs.
Ensuring a balanced and suitable diet, discussing diet changes with healthcare providers, and maintaining proper nutrient intake contribute significantly to managing IBD symptoms and promoting overall wellness in children and adolescents affected by this condition.