Inflammatory Bowel Disease

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is an inflammatory disease affecting approximately 1.6 million Americans, including as many as 80,000 children.  Most cases are diagnosed prior to the age of 35, making IBD one of the most significant chronic diseases affecting children and adolescents.

Cross sections of the colon illustration The immune system works as a network of cells and tissues to defend the body from infection.  In inflammatory diseases, like IBD, problems with the immune system cause the body’s antibodies and immune cells to mistake its own healthy cells as invaders.  Imagine an intruder, like a cold virus, invading your body.  Your immune system identifies, kills, and eliminates it from your body, protecting you from illness. In an inflammatory disease the immune system sometimes responds inappropriately and the body’s healthy cells are targeted, thus signaling the body to attack them.  This results in inflammation that can significantly affect a child’s quality of life. 

In both Crohn’s disease and ulcerative colitis, children have periods of no symptoms (remission) alternating with periods of inflammatory symptoms (flare).  Inflammation of the gastrointestinal (GI) tract occurs in both Crohn’s disease and ulcerative colitis, yet there are important difference between the two diseases.

Crohn's disease

Crohn's disease is characterized by a chronic inflammatory process that may affect any part of the GI tract, from the mouth to the anus, extending through one or more layers of the intestinal wall. It may appear in “patches,” affecting one area of the GI tract and not the next.

Ulcerative colitis

Ulcerative colitis is characterized by continuous segments of inflammation in the large intestine (colon) and the rectum.  Only the innermost layer of the intestinal wall is affected.

Causes of inflammatory bowel disease

While the exact cause of IBD is not entirely understood, research suggests that the inflammation in IBD involves an interaction between genes, environmental factors, and the immune system. Foreign substances (antigens) in the environment may directly cause inflammation, or they may “trigger” the body's defenses to produce inflammation that does not subside.

Once the immune system in a child with IBD is “switched on”, it may not know how to properly "switch off." As a result, the inflammation damages the tissues causing the symptoms of IBD. This is why a main focus of medical therapy is to help children regulate their immune system.

Treatment for inflammatory bowel disease

The therapy for IBD is complex and may be different for every child.  The main goals of medical treatment are to relieve symptoms, prevent flares, and achieve mucosal healing (healing of the intestine) and remission. Together, the ultimate aim is for a child to lead a normal life as possible and still be able to reach their personal goals.  In order to help guide the treatment process, we are able to perform many different tests, imaging, and procedures which paint a picture of what is going on inside the body.

Treatment with medication is one therapeutic option.  There is no “one size fits all” treatment for IBD.  Children respond to different medications or sometimes, a combination of medications.  Children requiring intravenous infusion therapies will be seen in our state of the art infusion center.

Nutritional therapy, often when used with medical treatment, is another important therapy that can include a variety of options.  In order for the body to heal, a child must have good nutrition.  We have IBD dieticians who work with families in nutritional support.

In instances when medication may not adequately control symptoms for children with IBD, or when disease complications arise, surgery may be a therapeutic option. Our surgeons who specialize in IBD are available to meet with families to guide the surgical process when necessary. Learn more about J-pouch Surgery and Bowel Resection Surgery.

These chronic diseases can be treated, but not yet cured.  As a team, we work with families to determine the best course of treatment for the child to promote the highest quality of life.

Reviewed by Andrew B. Grossman, MD, Judith R. Kelsen, MD

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