IBD (paeds)

Question 1

What is the prevalence of IBD in children in the UK?

Answer 1

c. 5.2/100,000/yr

7. 5% of these will be 5yrs or less

Question 2

What is the basic pathophysiology and presentation of Crohn’s?

Answer 2

Mouth to anus
Transmural inflammation
Discontinuous/skip lesions
Granuloma
Rectal sparing
Fissures, fistula, abscesses and strictures
Associated with perianal disease, mouth ulcers, clubbing, uveitis/conjunctivitis, arthritis, erythema nodosum

Question 3

What is the basic pathophysiology and presentation of UC?

Answer 3

Colon only affected
Mucosal inflammation
Continuous
No granuloma
No rectal sparing
Abscesses and strictures rare
Associated with primary sclerosing cholangitis

Question 4

How does paediatric IBD differ from adult?

Answer 4

Gender: prepubertal = M>F (equal in adults)

CD:UC - CD more common in paeds; UC more common in adults

Location:
CD - ielocolonic/colonic (paeds) vs terminal ileal without colon (adults
UC - pancolitis (paeds) vs left sided (adults)

Phenotype:
Peads - fewer strictures

Treatment: same paradigms for adults/paeds

Question 5

How do you mange Crohn’s disease?

Answer 5

Corticosteroids - Prednisolone

Immunomodulators - methotrexate, azathioprine, 6-metocarpurine

Biologics - infliximab, adalimumab

Antibiotics

Surgery, parenteral nutrition

Question 6

How do you manage UC?

Answer 6

5-ASA/sulphasalazine (aminosalicylate) for remission induction and maintenance in mild/moderate

Corticosteroids + immunosuppressants (e.g. azathioprine) for remission induction then maintenance in severe

Question 7

What do you see on histology of Crohn’s?

Answer 7

Lymphocytic infiltrate
Microscopic granulomas
Decreased goblet cells
Crypt abscesses