IBD

Question 1

How is IBD different in paeds?

Answer 1

more severe

Question 2

What is difficult in the management of IBD in paeds?

Answer 2

• Need to manage over teenage years
• Need to maintain growth and development
• Steroids will stop children growing so need to monitor that

Question 3

How is incidence of IBD changing?

Answer 3

Incidence is increasing

Question 4

What are the different presenting features of UC and Crohns?

Answer 4

• Diarrhoea: more prevalent in UC
• Rectal bleeding: more prevalent in UC
• Abdo pain: equal in both UC and crohns
• Fever: equal in both UC and crohns
• Weight loss: more prevalent in crohns
• Growth failure: more prevalent in crohns
• Arthritis: equal in both

Question 5

What is need for Dx?

Answer 5

• Intestinal symptoms (mouth ulcers, nausea vomiting, bowel movements)
• Extra-intestinal manifestations - in crohns particuarly important to discuss perianal disease
• Exclude infection (do stool sample)
• Family History
• Growth and sexual development
• Nutritional status

Question 6

What Ix do we do?

Answer 6

• In UC will often not get abnormal blood tests - doesn’t affect growth or blood tests >>>> BUT stool calprotectin will show up.
• With crohns – SSx will not be strong: tests will be abnormal (anaemia, raised ESR, raised CRP, high calprotectin)

Question 7

What other Ix can be definitive?

Answer 7

• Radiology (especially Crohn’s disease)
  
  • MRI , MRE
  • Barium meal and follow-through (younger kids)
• Endoscopy
  
  • Ileocolonoscopy
  • Upper GI endoscopy
  • Mucosal biopsy
  • Capsule endoscopy
  • Enteroscopy (uncommon)

Question 8

How does crohn’s appear?

Answer 8

• Snail slime appearance – ulcers, deep inflammation, why fistulas and perforation can occur

Question 9

What are the aims of treatment?

Answer 9

• Induce and maintain remission
• Correct nutritional deficiencies
• Maintain normal growth and developmenta

Question 10

What are the methods of treatment for paeds IBD?

Answer 10

• Medical
  
  • Anti-inflammatory
  • Immuno-suppressive
  • Biologicals ( Infliximab)
• Nutritional
  
  • Immune modulation
  • Nutritional supplementation
    
    • Milkshakes for 8 wks – 80% work for crohn’s kids.

Steroids is an option if polymeric diet is unsuccessful

• Ulcerative Colitis: Usually oral corticosteroids (ugly, put on weight, spots, puffy face) – to induce remission. Then 5 amino salycytlate to maintain remission.